K74.60 is the code most billing teams reach for the moment they see cirrhosis on a chart. It is billable, it passes edits, and it feels like a safe default. It is also, in a large share of encounters, the wrong code. Cirrhosis in ICD-10-CM is organized around etiology, not around the diagnosis itself, and the classification includes hard exclusion rules that make certain code pairings invalid outright. On top of that, cirrhosis carries real risk adjustment weight, so an unspecified code chosen out of habit costs the practice twice: once in accuracy and once in documented severity.
This guide walks through the K74 and K70 code families, the alcoholic versus non-alcoholic fork, the ascites rule that trips up nearly everyone, how NASH and MASH cirrhosis are handled, and why decompensated cirrhosis has no code of its own. Everything here is general billing education only.
Why Etiology Decides the Code
Unlike many diagnoses where one code covers the condition and modifiers add nuance, cirrhosis is split across multiple categories based on cause:
- Alcohol-related cirrhosis lives in K70.
- Toxic and drug-induced liver disease with cirrhosis lives in K71.
- Fibrosis and most other cirrhosis lives in K74.
- Cardiac cirrhosis, congenital cirrhosis, and pigmentary cirrhosis each sit elsewhere entirely.
This structure means the first question is never “which cirrhosis code”; it is “what caused it, and did the provider document that?”
The Cirrhosis Code Cheat Sheet
| ICD-10 Code | Description | When It Applies |
| K74.60 | Unspecified cirrhosis of liver | Cirrhosis documented, cause not stated |
| K74.69 | Other cirrhosis of liver | Non-alcoholic cause documented, no dedicated code exists |
| K70.30 | Alcoholic cirrhosis of liver without ascites | Documented alcoholic cirrhosis, no ascites |
| K70.31 | Alcoholic cirrhosis of liver with ascites | Documented alcoholic cirrhosis, ascites present |
| K74.3 | Primary biliary cholangitis | Formerly called primary biliary cirrhosis |
| K74.4 | Secondary biliary cirrhosis | Documented secondary biliary cause |
| K74.5 | Biliary cirrhosis, unspecified | Biliary origin, type not specified |
| K74.0- | Hepatic fibrosis | Fibrosis subcategory, includes staging subcodes |
| K74.1 | Hepatic sclerosis | Sclerosis without full cirrhosis picture |
| K74.2 | Hepatic fibrosis with hepatic sclerosis | Both documented together |
| K71.7 | Toxic liver disease with fibrosis and cirrhosis | Drug or toxin-induced |
| K76.1 | Chronic passive congestion of liver | Includes cardiac sclerosis of liver |
Note that K74.6 by itself is a parent code and is not billable. The fifth character is required, making K74.60 and K74.69 the two billable options in that subcategory.
K74.60 vs K74.69: The Specificity Fork
These two codes sit side by side and get used interchangeably, but they answer different questions.
K74.60, unspecified cirrhosis of liver, applies when cirrhosis is documented, and the underlying cause is not stated anywhere in the record. It is the honest code when the etiology genuinely is not known or not documented.
K74.69, other cirrhosis of liver, applies when a non-alcoholic cause is documented but no dedicated code exists for it. Common examples include cirrhosis secondary to steatohepatitis, cirrhosis following chronic viral hepatitis, and cryptogenic cirrhosis where the workup has been done and no cause was identified.
The practical distinction: K74.60 means nobody said what caused it. K74.69 means somebody did, and the classification has no specific code for that cause. Reaching for K74.60 when the chart clearly names a cause understates the clinical picture and weakens risk adjustment capture.
Alcoholic vs Non-Alcoholic: The Rule That Cannot Be Broken
This is the most consequential fork in cirrhosis coding, and ICD-10-CM enforces it with an Excludes1 note.
K74.60 carries an Excludes1 note for alcoholic cirrhosis (K70.3-). An Excludes1 note means the two conditions cannot be coded together on the same encounter. One code supersedes the other based on documented etiology. There is no scenario where both belong on the claim for the same cirrhosis.
| Factor | Alcoholic Cirrhosis (K70.3-) | Non-Alcoholic Cirrhosis (K74.6-) |
| Code range | K70.30, K70.31 | K74.60, K74.69 |
| Ascites handling | Built into the code itself | Requires a separate ascites code |
| Documentation trigger | Provider states “alcoholic cirrhosis” or equivalent | Any non-alcoholic or unstated etiology |
| Can be coded together | No, Excludes1 applies | No, Excludes1 applies |
| Additional codes expected | Alcohol use, abuse, or dependence from F10.- | Underlying cause code where applicable |
| Default when unclear | Not the default | K74.60 is the default |
The documentation bar matters here. Suspicion of alcohol use, or a social history noting drinking, does not support K70.3-. The provider must actually document alcoholic cirrhosis or alcohol-related cirrhosis as the diagnosis. Absent that link, the encounter defaults to K74.60 even if alcohol use appears elsewhere in the chart.
When K70.3- is supported, the applicable alcohol use, abuse, or dependence code from the F10 category should also be reported, since the classification expects that pairing.
Also Read: ICD-10 Codes For Chronic Pain: Complete Billing Guide
The Ascites Trap
Here is the asymmetry that generates more cirrhosis coding errors than anything else in this space.
For alcoholic cirrhosis, ascites is built into the code. K70.31 already means alcoholic cirrhosis with ascites. Adding a separate ascites code alongside it double-reports the same finding.
For non-alcoholic cirrhosis, no combination code exists. Cirrhosis with ascites in a non-alcoholic patient requires two codes: the cirrhosis code (K74.60 or K74.69) plus R18.8 for other ascites.
| Clinical Picture | Correct Coding |
| Alcoholic cirrhosis, no ascites | K70.30 alone |
| Alcoholic cirrhosis with ascites | K70.31 alone, no separate ascites code |
| Non-alcoholic cirrhosis, no ascites | K74.60 or K74.69 alone |
| Non-alcoholic cirrhosis with ascites | K74.60 or K74.69 plus R18.8 |
| Cirrhosis with ascites and spontaneous bacterial peritonitis | Base cirrhosis coding plus K65.2 for SBP |
Two opposite habits cause problems here. Adding R18.8 to K70.31 duplicates a finding already captured. Omitting R18.8 alongside K74.60 loses a documented complication that affects severity and risk adjustment. Both are avoidable once the asymmetry is understood.
NASH, MASH, and MASLD Cirrhosis
Clinical terminology moved faster than the code set here, and the gap causes real confusion.
The hepatology community has shifted from NASH (nonalcoholic steatohepatitis) to MASH (metabolic dysfunction-associated steatohepatitis), and from NAFLD to MASLD (metabolic dysfunction-associated steatotic liver disease). The change was made partly to remove stigma tied to alcohol-based naming.
ICD-10-CM has not created separate codes for the new terminology. Current mapping:
- MASH is coded as K75.81, the same code as NASH.
- MASLD is coded as K76.0, the same code as NAFLD.
For cirrhosis specifically, there is no combined code for NASH cirrhosis or MASH cirrhosis. When steatohepatitis has progressed to cirrhosis, both conditions are reported: K75.81 for the steatohepatitis and the appropriate cirrhosis code, generally K74.69 since the etiology is documented and non-alcoholic.
If a provider documents MASH cirrhosis using the newer terminology, the coding does not change. The classification is coded, not the clinical vocabulary.
Decompensated Cirrhosis Has No Single Code
Searches for a decompensated cirrhosis code come up empty for a reason: ICD-10-CM does not have one. Decompensation is captured by coding the base cirrhosis plus each documented complication.
| Complication | ICD-10 Code |
| Ascites (non-alcoholic cirrhosis) | R18.8 |
| Portal hypertension | K76.6 |
| Hepatic encephalopathy | K72.- as documented |
| Esophageal varices with bleeding | I85.01 |
| Esophageal varices without bleeding | I85.00 |
| Hepatorenal syndrome | K76.7 |
| Spontaneous bacterial peritonitis | K65.2 |
| Hepatic failure, unspecified | K72.90 |
The combination of the cirrhosis code plus its complications is what communicates decompensated status to the payer. A claim carrying only K74.60 for a patient with ascites, varices, and encephalopathy tells the payer far less than the record actually supports, which affects both severity capture and medical necessity for the services delivered.
Compensated cirrhosis, by contrast, is generally represented by the base cirrhosis code alone, with documentation showing the absence of these complications.
Cirrhosis From Viral Hepatitis
When cirrhosis results from chronic viral hepatitis, both conditions are reported. K74.60 carries a “code also” instruction for viral hepatitis when applicable. Chronic hepatitis C cirrhosis, for example, is typically reported with the appropriate cirrhosis code alongside the chronic hepatitis C code from the B18 category.
This pairing matters beyond documentation completeness. It supports medical necessity for antiviral therapy and for hepatocellular carcinoma surveillance imaging.
Risk Adjustment and Why Specificity Pays
Cirrhosis is a risk-adjusted condition under CMS Hierarchical Condition Category models. That has two practical consequences for billing teams.
First, the diagnosis must be captured at least annually with supporting documentation, since risk adjustment resets each year. A patient carried in the system as cirrhotic but never coded during the calendar year does not count.
Second, specificity and complications matter. The difference between a bare unspecified code and a properly documented picture with etiology and complications shows up directly in risk scores under value-based contracts.
Why There Is No “History of Cirrhosis” Code
Practices sometimes look for a personal history Z code for cirrhosis, similar to those available for resolved conditions. None exists, and the reason is clinical. Cirrhosis represents permanent structural scarring of the liver. It does not resolve.
A patient with cirrhosis remains a patient with cirrhosis, even when the disease is well compensated and asymptomatic. The active cirrhosis code continues to apply. Coding a stable cirrhotic patient as history rather than active understates their clinical status and removes a legitimate risk-adjusted diagnosis from the record.
Documentation That Supports Clean Cirrhosis Claims
Strong cirrhosis documentation consistently captures:
- The etiology, stated explicitly, whether alcoholic, viral, metabolic, biliary, autoimmune, or cryptogenic after workup.
- Presence or absence of ascites.
- Every complication present, named individually.
- Compensated or decompensated status supported by findings.
- Relevant labs such as bilirubin, albumin, INR, and platelet count.
- Imaging or biopsy findings supporting the diagnosis.
- For alcohol-related cases, the documented link between alcohol use and the liver disease.
A note reading “cirrhosis secondary to chronic hepatitis C, decompensated with ascites and grade 2 varices, no encephalopathy” gives a billing team everything needed to code the etiology, the complications, and the severity accurately.
Common Cirrhosis Coding Pitfalls
At Zee Medical Billing LLC, we often see the same patterns weaken cirrhosis claims across gastroenterology and primary care:
- Defaulting to K74.60 when the chart documents a specific cause that supports K74.69 or a dedicated etiology code.
- Adding R18.8 alongside K70.31, duplicating ascites already built into the code.
- Omitting R18.8 when non-alcoholic cirrhosis presents with documented ascites.
- Attempting to report K74.60 and K70.30 together, which the Excludes1 note prohibits.
- Assigning K70.3- based on social history alcohol mentions rather than a documented diagnostic link.
- Reporting only the cirrhosis code for a decompensated patient, leaving complications uncoded.
- Missing the F10 alcohol use code alongside alcoholic cirrhosis.
- Searching for a decompensated cirrhosis code instead of building the picture with complication codes.
- Treating stable cirrhosis as resolved history rather than an active diagnosis.
Most of these come down to one habit: reading the full note for etiology and complications rather than coding from the diagnosis line alone.
FAQs
What is the ICD-10 code for cirrhosis of the liver?
The most commonly reported code is K74.60, unspecified cirrhosis of liver, used when cirrhosis is documented without a stated cause. However, the correct code depends entirely on etiology. Alcoholic cirrhosis uses K70.30 or K70.31 depending on ascites; biliary causes use K74.3 through K74.5; toxic causes use K71.7; and documented non-alcoholic causes without a dedicated code use K74.69. K74.6 alone is a parent code and is not billable.
What is the difference between K74.60 and K74.69?
K74.60 is unspecified cirrhosis, appropriate when the record does not state what caused the cirrhosis. K74.69 is other cirrhosis of the liver, appropriate when a non-alcoholic cause is documented but the classification has no dedicated code for it, such as cirrhosis secondary to steatohepatitis or cryptogenic cirrhosis after a completed workup. The choice hinges on whether the provider documented an etiology, not on how severe the cirrhosis is.
How do you code cirrhosis with ascites?
It depends on the etiology. For alcoholic cirrhosis, K70.31 is a combination code that already includes ascites, so no separate ascites code is added. For non-alcoholic cirrhosis, no combination code exists, so the cirrhosis code (K74.60 or K74.69) is reported along with R18.8 for other ascites. This asymmetry between alcoholic and non-alcoholic cirrhosis is one of the most frequent sources of coding errors in this area.
How is NASH or MASH cirrhosis coded?
There is no single combined code for NASH cirrhosis or MASH cirrhosis. Both conditions are reported: K75.81 for the steatohepatitis and the appropriate cirrhosis code, generally K74.69 since the etiology is documented and non-alcoholic. Although clinical terminology has shifted from NASH to MASH and from NAFLD to MASLD, ICD-10-CM has not added separate codes for the newer terms. MASH continues to map to K75.81 and MASLD to K76.0.
Is there an ICD-10 code for decompensated cirrhosis?
No. ICD-10-CM does not include a code specifically for decompensated cirrhosis. Decompensation is communicated by reporting the base cirrhosis code alongside each documented complication, such as R18.8 for ascites, K76.6 for portal hypertension, codes from the K72 category for hepatic encephalopathy, I85.01 for bleeding esophageal varices, or K76.7 for hepatorenal syndrome. Together, these codes convey the decompensated picture that no single code can capture.
Conclusion
Cirrhosis coding rewards teams that read for etiology first and complications second. K74.60 has its place, but it belongs on claims where the cause genuinely is not documented, not on every cirrhotic patient by default. The alcoholic versus non-alcoholic fork, the ascites asymmetry, and the absence of a decompensated cirrhosis code are the three details that separate accurate claims from convenient ones.
Key takeaways:
- Let documented etiology drive the code selection, not habit.
- Use K74.60 only when no cause is documented, and K74.69 when a non-alcoholic cause is.
- Never report K74.60 and K70.3- together, since an Excludes1 note prohibits it.
- Remember that K70.31 includes ascites while K74.6- requires R18.8 separately.
- Report K75.81 alongside the cirrhosis code for NASH or MASH cirrhosis.
- Build the decompensated picture through complication codes, since no single code exists.
- Code cirrhosis as an active diagnosis, because there is no history code for a permanent condition.
Accurate etiology documentation and complete complication capture are what keep cirrhosis claims defensible and risk scores reflective of the patients actually being treated.
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