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Pinson and Tang CDI Pocket Guide
Pinson & Tang

Chronic vs. Acute Liver Failure

November 9, 2020

According to the CDC, 4.5 million Americans have chronic liver disease and almost 48,000 die from it each year. 

From a coding and CDI perspective, chronic (or unspecified) liver failure is a non-CC and acute liver (hepatic) failure is classified as an MCC. How do we recognize chronic vs. acute liver failure?  

Other laboratory and clinical findings in liver failure include elevated creatinine, amylase/lipase, GGT, alkaline phosphatase, LDH; low pre-albumin/albumin; anemia. Physical findings include jaundice, hepatomegaly, RUQ/liver tenderness, ascites/edema, and asterixis (rhythmic “flapping” of hands when wrists held fully extended). 

What is hepatic encephalopathy? Patients with chronic liver failure are often admitted with hepatic encephalopathy which describes a spectrum of neurologic impairment. Symptoms include altered mental status, confusion, disorientation, inappropriate behavior, combativeness, gait disturbances, and/or altered level of consciousness ranging from drowsiness to deep coma. It is confirmed by an elevated level of neurotoxic blood ammonia.

Hepatic encephalopathy does not have its own ICD-10 code and is indexed to “hepatic failure, not elsewhere classified” (category K72). While often it is the principal reason for admission, as a secondary diagnosis it is a non-CC, but if “with coma” it is an MCC. Indicators of coma include GCS total score of < 8, abnormal EEG, and documentation of unconsciousness, stupor, obtundation.

Provider documentation of “acute” or “subacute” hepatic encephalopathy should not be coded as acute liver failure unless the liver failure itself is acute, subacute or decompensated – see indicators in the table above.

More information about liver failure and hepatic encephalopathy is contained in our 2021 CDI Pocket Guide and CDI Pocket Guide Unbound Edition.

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