If you’ve ever faced uncertainty when selecting the correct ICD 10 code for elevated liver enzymes, you’re not alone. Whether you’re a healthcare provider documenting a diagnosis or a medical biller trying to get claims paid correctly, understanding which code to use—and when—is essential.
With changes in documentation standards and payer requirements, coding errors can lead to claim rejections, compliance issues, and reimbursement delays. In this guide, we’ll demystify the ICD 10 code for elevated liver enzymes, walk you through R74.01, and explain when related codes might apply.
What Are Elevated Liver Enzymes?
Elevated liver enzymes typically signal that the liver is inflamed or damaged. These enzymes—primarily ALT (alanine transaminase) and AST (aspartate transaminase)—are released into the bloodstream when liver cells are injured. Elevated levels can show up in routine blood work and often require further evaluation to uncover the underlying cause.
Common causes include:
- Non-alcoholic fatty liver disease (NAFLD)
- Alcoholic liver disease
- Hepatitis (viral, autoimmune, or drug-induced)
- Medications or toxins
- Hemochromatosis or other metabolic disorders
While elevated liver enzymes aren’t a diagnosis on their own, they are an important clinical indicator that something is affecting liver health. That’s why accurate coding is crucial—it ensures that the patient’s condition is appropriately documented and billed.
Primary ICD 10 Code for Elevated Liver Enzymes
The most appropriate ICD 10 code for elevated liver enzymes in most cases is:
➡ R74.01 – Elevation of levels of liver transaminase levels
This code is used when liver enzyme elevations are documented, but no definitive liver disease is diagnosed. It reflects abnormal findings in liver function without a clearly identified cause, which is common in outpatient follow-up or early diagnostic stages.
Use Case Example:
A 55-year-old patient has mildly elevated ALT and AST found on routine labs. No signs of hepatitis or liver disease are confirmed yet. You would document:
- Diagnosis: Elevated liver enzymes
- ICD 10 Code: R74.01
When to Use R74.01:
- Elevated AST/ALT with no identified liver disease
- Incidental abnormal labs during routine workups
- Temporary enzyme changes due to medication
Supporting and Related ICD 10 Codes for Elevated Liver Enzymes
Sometimes, R74.01 isn’t enough. If the elevated enzymes are part of a broader clinical picture or linked to a specific liver disease, a more targeted ICD-10 code should be used. Here are the most relevant options:
R94.5 – Abnormal results of liver function studies
Use when the elevation is part of a broader set of abnormal lab findings, but without a confirmed diagnosis.
K71.x Series – Toxic Liver Disease Codes
These codes apply when elevated liver enzymes are caused by drugs, toxins, or chemicals. Each code pinpoints a specific type of liver response:
- K71.0 – Toxic liver disease with cholestasis
- K71.1 – …with hepatic necrosis
- K71.2 – …with acute hepatitis
- K71.3 – …with chronic persistent hepatitis
- K71.4 – …with chronic lobular hepatitis
- K71.50 – …with chronic active hepatitis, not elsewhere classified
- K71.6 – …with hepatitis, not elsewhere classified
- K71.7 – …with fibrosis and cirrhosis
These are diagnostic-specific codes and require strong clinical documentation to support their use.
When to Choose These Over R74.01?
If the provider determines a specific diagnosis like toxic hepatitis, cholestasis, or drug-induced liver injury, R74.01 becomes too general. Choose from the K71 series instead.
When to Use R74.01 vs. Other Codes?
Choosing between R74.01 and other liver-related ICD-10 codes comes down to clinical specificity.
✔️ Use R74.01 when:
- The patient has elevated AST/ALT but no confirmed diagnosis.
- Labs are mildly or moderately elevated with no liver disease documentation.
- You’re in the early stages of workup and haven’t ruled in or out a disease process.
❌ Avoid R74.01 when:
The provider documents a specific condition, such as:
- Drug-induced hepatitis → use K71.2
- Chronic viral hepatitis → consider B18.x series
- Fatty liver or NASH → use K76.0 or K75.81
There’s evidence of toxic liver injury or structural disease, and a K71 series code is more appropriate.
Example Comparison:
Coding Tips for Medical Billers
Billing for elevated liver enzymes doesn’t end with diagnosis—it starts there. Medical billers play a critical role in ensuring documentation supports reimbursement.
Best Practices:
Match ICD-10 codes with CPT codes for liver-related labs and services:
- 80076 – Hepatic function panel
- 84460 – Alanine aminotransferase (ALT)
- 84450 – Aspartate aminotransferase (AST)
Always verify documentation reflects the medical necessity of the test and ties directly to the diagnosis code used.
If elevation is linked to medication toxicity or a chronic liver issue, query the provider for specific documentation before billing.
Use R94.5 for broader abnormal liver studies if ALT/AST are not the only findings.
Payer-Specific Considerations:
Some insurance plans may require specificity beyond R74.01—especially when linked to prescription drug coverage or diagnostic imaging. Check with your clearinghouse or MAC (Medicare Administrative Contractor) for local coverage determinations (LCDs).
Best Practices for Healthcare Providers
Correct ICD-10 coding starts with clear documentation. Here’s what providers can do to help ensure compliance and accurate billing:
- Document the specific enzyme elevations (ALT, AST) and interpret the findings.
- Avoid vague terms like “liver panel abnormal” unless pairing with R94.5.
- Indicate whether further workup is planned or if this is an incidental finding.
- Coordinate with billing staff to resolve unclear diagnoses before claim submission.
Bottom Line
Using the right ICD 10 code for elevated liver enzymes—especially R74.01—is essential for accurate diagnosis coding and clean claim submissions. In cases where a more defined liver disease exists, the use of the K71.x or related codes is not just better practice—it’s necessary for reimbursement and medical clarity.
For both providers and billers, understanding when and how to apply these codes ensures you stay compliant, get paid properly, and deliver better patient care.
