2027 ICD-10-CM Diagnosis Code K72.91Hepatic failure, unspecified with coma
ICD-10-CM Codes›K00–K95›K70-K77›K72
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 63
- Chronic Condition
K72.91 is a billable ICD-10-CM diagnosis code for hepatic failure, unspecified with coma. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 441 through 443, 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 5 closely related codes. Coders also document this condition as hepatic coma due to chronic hepatitis B. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Coma; stupor; and brain damage and Hepatic failure.
For Medicare Advantage risk adjustment, K72.91 maps to CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders) under the V28 model, adding a risk factor of about 0.962 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K72.91 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Hepatic coma due to chronic hepatitis B
- Hepatic coma due to chronic hepatitis B with delta agent
- Hepatic coma due to chronic hepatitis C
- Hepatic coma due to viral hepatitis
- Hepatic coma due to viral hepatitis B
- Hepatic coma due to viral hepatitis C
- Hepatic coma due to viral hepatitis D
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K72.91: its own notes plus those printed at K72, block K70-K77, and Chapter 11. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- fulminant hepatitis NEC, with hepatic failure
- liver (cell) necrosis with hepatic failure
- malignant hepatitis NEC, with hepatic failure
- yellow liver atrophy or dystrophy
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Hepatic coma NOS
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- jaundice NOS (R17)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K72.91, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming K72.91: they are not reported together with it, unless the two conditions are unrelated.
- K76.82 Hepatic encephalopathyhepatic failure with coma (K72.91)
- K76.2 Central hemorrhagic necrosis of liverliver necrosis with hepatic failure (K72.-) names K72.-, which includes this code
- R40 Somnolence, stupor and comasomnolence, stupor and coma in hepatic failure (K72.-) names K72.-, which includes this code
Use Additional Code 1
These codes say to use an additional code from the note, and K72.91 is one of the codes named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Liver Failure
severe inability of the liver to perform its normal metabolic functions, as evidenced by severe jaundice and abnormal serum levels of ammonia; bilirubin; alkaline phosphatase; aspartate aminotransferase; lactate dehydrogenases; and albumin/globulin ratio. (blakiston's gould medical dictionary, 4th ed)
Patient EducationClinical
Coma
A coma is a deep state of unconsciousness. An individual in a coma is alive but unable to move or respond to his or her environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as brain injury.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K72.91 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K72.91Overview
What is the ICD-10 code for hepatic failure, unspecified with coma?
The ICD-10-CM code for hepatic failure, unspecified with coma is K72.91 (sometimes written as K7291). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K72.91 (Hepatic failure, unspecified) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hepatic failure, unspecified with coma on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K72.91 group to?
When hepatic failure, unspecified with coma is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 442, 441, 443, with relative weights from 0.6890 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is K72.91 a CC or MCC?
CMS lists K72.91 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 5 closely related codes in its exclusion list.
Can K72.91 be reported with K70.4?
Not as a rule. The Excludes1 note at K72, which applies to K72.91, lists "alcoholic hepatic failure (K70.4)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is K72.91?
K72.91 (hepatic failure, unspecified with coma) maps to CMS-HCC Category 63 (Chronic Liver Failure/End-Stage Liver Disorders), commonly written as HCC 63, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 27 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does K72.91 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K72.91 adds a risk adjustment factor of about 0.962 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.861 to 1.209 depending on the payment segment). A more severe related category (HCC 62) supersedes it when both are reported. See the full factor table on the HCC 63 category page.
