2027 ICD-10-CM Diagnosis Code K74.5Biliary cirrhosis, unspecified
ICD-10-CM Codes›K00–K95›K70-K77›K74
- Billable — Valid for Submission
- Risk Adjusts — HCC 68
- Chronic Condition
K74.5 is a billable ICD-10-CM diagnosis code for biliary cirrhosis, unspecified. 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, K74.5 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
K74.5 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.
- Biliary cirrhosis
- Chronic clonorchiasis
- Clonorchiasis
- Clonorchiasis with biliary cirrhosis
- Fibrosis of bile duct
- Infection of bile duct caused by parasite
- Infectious cirrhosis
- Obstructive biliary cirrhosis
- Opisthorchiasis
- Parasitic cirrhosis
- Secondary biliary cirrhosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K74.5: 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.
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)
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.
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 Cirrhosis, Biliary
fibrosis of the hepatic parenchyma due to obstruction of bile flow (cholestasis) in the intrahepatic or extrahepatic bile ducts (bile ducts, intrahepatic; bile ducts, extrahepatic). primary biliary cholangitis involves the destruction of small intra-hepatic bile ducts and decreased bile secretion. secondary biliary cholangitis is produced by prolonged obstruction of large intrahepatic or extrahepatic bile ducts from a variety of causes.
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 K74.5 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K74.5Overview
What is the ICD-10 code for biliary cirrhosis, unspecified?
The ICD-10-CM code for biliary cirrhosis, unspecified is K74.5 (sometimes written as K745). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K74.5 (Fibrosis and cirrhosis of liver) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report biliary cirrhosis, unspecified on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K74.5 group to?
When biliary cirrhosis, unspecified 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 K74.5 be reported with K70.3?
Not as a rule. The Excludes1 note at K74, which applies to K74.5, 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 K74.5?
Under the General Equivalence Mappings, biliary cirrhosis, unspecified converts to ICD-9-CM 571.6 (biliary cirrhosis). The mapping is approximate, so confirm the match fits the documentation.
What HCC is K74.5?
K74.5 (biliary cirrhosis, unspecified) 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. It does not map to any RxHCC in the Part D prescription drug model.
Does K74.5 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K74.5 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.
