2027 ICD-10-CM Diagnosis Code K74.3Primary biliary cirrhosis
ICD-10-CM Codes›K00–K95›K70-K77›K74
- Billable — Valid for Submission
- Risk Adjusts — HCC 68
- Chronic Condition
K74.3 is a billable ICD-10-CM diagnosis code for primary biliary cirrhosis. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 432 through 434. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified and unspecified liver disease.
For Medicare Advantage risk adjustment, K74.3 maps to CMS-HCC Category 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones) under the V28 model, adding a risk factor of about 0.388 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K74.3 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.
- Autoimmune cholangitis
- Autoimmune hepatitis
- Autoimmune liver disease
- Biliary cirrhosis
- Cholangiohepatitis
- Cholangiolitic cirrhosis
- Cholangiolitis
- Fibrosis of bile duct
- Florid cirrhosis
- Limited systemic sclerosis
- Primary biliary cholangitis
- Reynolds syndrome
- Systemic sclerosis with limited cutaneous involvement
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K74.3: its own notes plus those printed at K74, block K70-K77, and Chapter 11. A note printed at a category, block or chapter applies to every code under it.
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.
- Chronic nonsuppurative destructive cholangitis
- Primary biliary cholangitis
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.
- primary sclerosing cholangitis (K83.01)
- 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)
Code Also
A second code may be needed to fully describe the condition; the note gives no sequencing direction.
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name K74.3, its category, or a range that includes it.
Excludes2 3
These codes carry an Excludes2 note naming K74.3: its condition is not part of those codes, and both may be reported when the patient has both.
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
Primary Biliary Cholangitis
an autoimmune inflammatory disorder characterized by destruction of the small intrahepatic bile ducts. it affects predominantly females and it may lead to cirrhosis and liver failure. patients have antimitochondrial and antinuclear antibodies in the peripheral blood.
Patient EducationClinical
Bile Duct Diseases
Your liver makes a digestive juice called bile. Your gallbladder stores it between meals. When you eat, your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. The bile helps break down fat. It also helps the liver get rid of toxins and wastes.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K74.3 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K74.3Overview
What is the ICD-10 code for primary biliary cirrhosis?
The ICD-10-CM code for primary biliary cirrhosis is K74.3 (sometimes written as K743). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K74.3 (Fibrosis and cirrhosis of liver) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report primary biliary cirrhosis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K74.3 group to?
When primary biliary cirrhosis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 433, 434, 432, with relative weights from 0.6247 to 1.9828 depending on complications. Higher weights mean higher Medicare reimbursement.
Can K74.3 be reported with K70.3?
Not as a rule. The Excludes1 note at K74, which applies to K74.3, lists "alcoholic cirrhosis (of liver) (K70.3)". 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 is the ICD-9 equivalent of K74.3?
Under the General Equivalence Mappings, primary biliary cirrhosis converts to ICD-9-CM 571.6 (biliary cirrhosis). The mapping is approximate, so confirm the match fits the documentation.
What HCC is K74.3?
K74.3 (primary biliary cirrhosis) maps to CMS-HCC Category 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones), commonly written as HCC 68, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 28 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 59.
Does K74.3 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K74.3 adds a risk adjustment factor of about 0.388 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.085 to 0.391 depending on the payment segment). A more severe related category (HCC 62, HCC 63, and HCC 64) supersedes it when both are reported. See the full factor table on the HCC 68 category page.
