Liver Injury Due to Drugs
We have a patient who has rheumatoid arthritis and ulcerative colitis being treated with Methotrexate and Leflunomide.
Her liver function tests are all elevated. The doctor writes:
76-year-old white female with longstanding history of rheumatoid arthritis, maintained on methotrexate baseline, currently with recent addition of Arava (leflunomide) with multiple side effects currently including drug-induced liver injury and secondary abnormal liver chemistries, trending downwards currently.
The advice in this coding clinic has me a little confused. Do you think in this case I should clarify for acute hepatitis, or go for the acute/subacute liver failure, or is there another ICD-10 code more appropriate?
AHA Coding Clinicâ for ICD-10-CM and ICD-10 PCS, 2Q 2015, Volume 2, Number 2, Page 17
The patient was diagnosed with acute liver injury as well as acute hepatitis, nonviral. Code S36.119, Unspecified injury of liver, does not seem to apply since there was no documentation of a traumatic injury to the liver. How should nontraumatic acute liver injury be coded?
Code the exact nature of the liver problem, if known. If the etiology of the liver injury is not clearly documented, query the provider for clarification.
For this example, assign code K72.00, Acute and subacute hepatic failure without coma, for non-viral acute hepatitis.
In ICD-10-CM there is no Index entry for “acute hepatitis, nonviral.” However, the Alphabetic Index, under the term “Hepatitis” leads to code K75.9, Inflammatory liver disease, unspecified. Code K75.9 has an Excludes 1 note: acute or subacute hepatitis (K72.0-).
Thanks for your help,