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K75.4 ICD-10-CM Code: Autoimmune hepatitis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1 · 5 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 29

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 441 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC (MDC 07)
  • MS-DRG 442 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC (MDC 07)
  • MS-DRG 443 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC (MDC 07)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 65 — Chronic Hepatitis

Other models: CMS-HCC V22 HCC 29

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K75.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on K75.4 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Lupoid hepatitis NEC

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from K70-K77

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for K75.4

MedCoder structured workflow — derived from this code’s own official record

Before you code K75.4

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with K75.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in K75.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewR17

Consider K75.4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting K75.4(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K75.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareR17

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of K75.4(5 notes)

    Coding workflow: The conditions named in this note are not included in K75.4. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareK71, E83.11, G93.7, E83.01

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition K75.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewR17

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Autoimmune hepatitis is a billable ICD-10-CM diagnosis code (K75.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Chapter 11: Diseases of the Digestive System (K00-K95)

Reserved for future guideline expansion

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 3 MS-DRGs: DRG 441 (MDC 07), DRG 442 (MDC 07), DRG 443 (MDC 07).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):DIG023 — Noninfectious hepatitis (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Chronic Hepatitis) for risk-adjusted payment.

B18.0 — Chronic viral hepatitis B with delta-agent, B18.1 — Chronic viral hepatitis B without delta-agent, B18.2 — Chronic viral hepatitis C, B18.8 — Other chronic viral hepatitis, B18.9 — Chronic viral hepatitis, unspecified, K70.10 — Alcoholic hepatitis without ascites, K70.11 — Alcoholic hepatitis with ascites, K71.3 — Toxic liver disease with chronic persistent hepatitis, K71.4 — Toxic liver disease with chronic lobular hepatitis, K71.50 — Toxic liver disease with chronic active hepatitis without ascites, K71.51 — Toxic liver disease with chronic active hepatitis with ascites, K73.0 — Chronic persistent hepatitis, not elsewhere classified, K73.1 — Chronic lobular hepatitis, not elsewhere classified, K73.2 — Chronic active hepatitis, not elsewhere classified, K73.8 — Other chronic hepatitis, not elsewhere classified, K73.9 — Chronic hepatitis, unspecified

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Liver Transplant Status/Complications, Chronic Liver Failure/End-Stage Liver Disorders, Cirrhosis of Liver

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Noninfectious hepatitis).

K71.2 — Toxic liver disease with acute hepatitis, K71.3 — Toxic liver disease with chronic persistent hepatitis, K71.4 — Toxic liver disease with chronic lobular hepatitis, K71.50 — Toxic liver disease with chronic active hepatitis without ascites, K71.51 — Toxic liver disease with chronic active hepatitis with ascites, K71.6 — Toxic liver disease with hepatitis, not elsewhere classified, K73.0 — Chronic persistent hepatitis, not elsewhere classified, K73.1 — Chronic lobular hepatitis, not elsewhere classified, K73.2 — Chronic active hepatitis, not elsewhere classified, K73.8 — Other chronic hepatitis, not elsewhere classified, K73.9 — Chronic hepatitis, unspecified, K75.2 — Nonspecific reactive hepatitis, K75.3 — Granulomatous hepatitis, not elsewhere classified, K75.81 — Nonalcoholic steatohepatitis (NASH)

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Hepatitis”; these codes share that main term but sit in a different category of the Tabular List.

B33.8 — Other specified viral diseases (viral, virus, coxsackie), B58.1 — Toxoplasma hepatitis (in, toxoplasmosis), K70.10 — Alcoholic hepatitis without ascites (alcoholic), K70.11 — Alcoholic hepatitis with ascites (alcoholic, with ascites), K71.6 — Toxic liver disease with hepatitis, not elsewhere classified (toxic), K72.0 — Acute and subacute hepatic failure (acute, non-viral), K72.00 — Acute and subacute hepatic failure without coma (shock), K72.01 — Acute and subacute hepatic failure with coma (acute, with coma), K72.90 — Hepatic failure, unspecified without coma (malignant NEC), K72.91 — Hepatic failure, unspecified with coma (malignant NEC, with coma), K73.0 — Chronic persistent hepatitis, not elsewhere classified (chronic, persistent NEC), K73.1 — Chronic lobular hepatitis, not elsewhere classified (chronic, lobular NEC), K73.2 — Chronic active hepatitis, not elsewhere classified (chronic, active NEC), K73.8 — Other chronic hepatitis, not elsewhere classified (chronic, specified NEC), K73.9 — Chronic hepatitis, unspecified (chronic), K74.69 — Other cirrhosis of liver (interstitial), P35.3 — Congenital viral hepatitis (viral, virus, congenital), P37.1 — Congenital toxoplasmosis (in, toxoplasmosis, congenital), P59.29 — Neonatal jaundice from other hepatocellular damage (newborn), Z86.19 — Personal history of other infectious and parasitic diseases (history of, B), +31 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Alpha-Fetoprotein (AFP) Test, Fecal Occult Blood Test (FOBT), Gamma-glutamyl Transferase (GGT) Test, Iron Panel, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of K75.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 65 — Chronic Hepatitis [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 07 — Diseases and Disorders of the Hepatobiliary System and Pancreas[MDC crossing]: “Diseases and Disorders of the Hepatobiliary System and Pancreas — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 2,481 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Hepatitis, autoimmune[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hepatitis, lupoid NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (9)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "K75.4 — Autoimmune hepatitis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/k75.4-autoimmune-hepatitis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Autoimmune hepatitis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K75.4 in its code family, with their registry titles.

View all codes in the K75 family