2027 ICD-10-CM Diagnosis Code K75.4Autoimmune hepatitis
ICD-10-CM Codes›K00–K95›K70-K77›K75
- Billable — Valid for Submission
- Risk Adjusts — HCC 65
- Chronic Condition
K75.4 is a billable ICD-10-CM diagnosis code for autoimmune hepatitis. 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. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Noninfectious hepatitis.
For Medicare Advantage risk adjustment, K75.4 maps to CMS-HCC Category 65 (Chronic Hepatitis) under the V28 model, adding a risk factor of about 0.185 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
K75.4 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.
- Autoantibody negative autoimmune hepatitis
- Autoimmune hepatitis
- Autoimmune hepatitis type 1
- Autoimmune hepatitis type 2
- Autoimmune hepatitis type 3
- Autoimmune liver disease
- Bleeding esophageal varices
- Bleeding esophageal varices due to autoimmune hepatitis
- Cholangiohepatitis
- Chronic autoimmune hepatitis
- Esophageal varices associated with another disorder
- Lupus hepatitis
- Primary biliary cholangitis and/or primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to K75.4: its own notes plus those printed at K75, 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.
- Lupoid hepatitis NEC
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)
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.
autoimmune K75.4
lupoid NEC K75.4
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Hepatitis, Autoimmune
a chronic self-perpetuating hepatocellular inflammation of unknown cause, usually with hypergammaglobulinemia and serum autoantibodies.
Patient EducationClinical
Autoimmune Diseases
Your immune system protects you from disease and infection by attacking germs that get into your body, such as viruses and bacteria. Your immune system can tell that the germs aren't part of you, so it destroys them. If you have an autoimmune disease, your immune system attacks the healthy cells of your organs and tissues by mistake.
The full article covers:
- What are autoimmune diseases?
- What causes autoimmune diseases?
- Who is at risk for autoimmune diseases?
- What are the symptoms of autoimmune diseases?
- How are autoimmune diseases diagnosed?
- What are the treatments for autoimmune diseases?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert K75.4 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About K75.4Overview
What is the ICD-10 code for autoimmune hepatitis?
The ICD-10-CM code for autoimmune hepatitis is K75.4 (sometimes written as K754). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is K75.4 (Other inflammatory liver diseases) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report autoimmune hepatitis on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does K75.4 group to?
When autoimmune hepatitis is the principal diagnosis on an inpatient stay, it groups to MS-DRG 442, 441, 443, with relative weights from 0.6890 to 1.8226 depending on complications. Higher weights mean higher Medicare reimbursement.
Can K75.4 be reported with R17?
Not as a rule. The Excludes1 note at block K70-K77, which applies to K75.4, lists "jaundice NOS (R17)". 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 K75.4?
Under the General Equivalence Mappings, autoimmune hepatitis converts to ICD-9-CM 571.42 (autoimmune hepatitis). The mapping is a direct match.
What HCC is K75.4?
K75.4 (autoimmune hepatitis) maps to CMS-HCC Category 65 (Chronic Hepatitis), commonly written as HCC 65, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 29 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 K75.4 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, K75.4 adds a risk adjustment factor of about 0.185 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.101 to 0.378 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 65 category page.
