Liver failure w/wo hepatic encephalopathy, not specified as acute or chronic

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ICD10 Diagnosis
Dx: Liver failure w/wo hepatic encephalopathy, not specified as acute or chronic
ICD10 code: K72.9
Pre-ICD10 counterpart: Non Fulminant Hepatic Failure
Charlson/ALERT Scale: Moderate or severe liver disease
APACHE Como Component: Liver
APACHE Acute Component: none
External ICD10 Documentation
This diagnosis is a part of ICD10 collection.

Additional Info

  • This is a wastebasket code to use for liver failure:
    • When the TIMING of its onset isn't clear -- i.e. not clear if fulminant/acute, subacute, or chronic. If the timing IS clear, don't use this code.
    • With or without hepatic encephalopathy
    • NOT due to ethanol or another drug/toxin.
  • Also code the cause of the liver failure, if known -- unless it's alcohol or another drug/toxin, as liver failure due to those have their own codes.
  • Remember that liver failure is a distinct manifestation of advanced liver disease that can be caused by many different types of liver disease. In liver failure, there is evidence of one or both of:
    • synthetic dysfunction indicated by coagulopathy (with elevated PT, INR), very low albumin and other plasma proteins
    • hepatic encephalopathy
  • Liver cirrhosis is NOT the same thing as liver failure. They can occur alone, or together.
  • Non Fulminant Hepatic failure - refers to liver failure that has been on a steady decline. End of the line due to a chronic underlying know liver disease.

DEFINITION — Fulminant hepatic failure refers to the rapid development of severe liver injury resulting in impaired function and encephalopathy in a person who previously had a normal liver or had well-compensated liver disease. Several definitions of the time course for which liver failure should be considered fulminant have been proposed but are not standard:

  • The development of encephalopathy within eight weeks of the onset of symptoms in a patient with a previously healthy liver.
  • The appearance of encephalopathy within two weeks of developing jaundice, even in a patient with previous underlying liver dysfunction.
  • Patients who have rapid deterioration of liver function with the development of encephalopathy within six months but fall outside the boundaries of the above time intervals are considered to have "subfulminant" hepatic failure.

Fulminant liver failure (FLF), is a rare condition in which rapid deterioration of liver function results in altered mentation and coagulopathy in previously normal individuals. U.S. estimates are placed at approximately 2,000 cases per year. The most prominent causes include drug-induced liver injury, viral hepatitis, autoimmune liver disease, and shock or hypoperfusion; many cases (20 percent) have no discernible cause. Fulminant liver failure often affects young persons and carries a high morbidity and mortality. Prior to transplantation, most series suggested less than 15 percent survival. Currently, overall short-term survival with transplantation is greater than 65 percent. Because of its rarity, FLF has been difficult to study in depth and very few controlled therapy trials have been performed. As a result, standards of intensive care for this condition have not been established.

  • Subacute hepatic failure (SAHF) is now recognized as distinct disease with characteristics of progressive hepatic failure defined by clinical and biochemical criteria [1]. There has been lot of controversy regarding the time frame by which hepatic failure occurs as well as clinical features particularly presence of encephalopathy [2]. Acute liver failure is characterized by onset of encephalopathy within 8 weeks of appearance of jaundice where as chronic liver failure is defined as hepatic decompensation occuring 24 weeks after the onset of liver disease. SAHF is now characterized by gradual deterioration of hepatic function between 8 and 24 weeks of onset of jaundice.

Altered mental status

Coding altered mental status in ICD10 can be complex, see ICD10 Guideline for coding altered mental status for more info.

Alternate ICD10s to consider coding instead or in addition

  • This is one of several different codes for liver failure:
Liver failure codes:
Liver disease codes:
encephalopathy codes:

Candidate Combined ICD10 codes

Code the cause if known, e.g. shock liver

Hepatitis codes:
  • others

Related CCI Codes

Data Integrity Checks (SMW)

none found

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