Learn about cholestatic liver injury, including drug-induced cholestatic hepatitis and toxic liver disease with cholestasis. This resource provides information relevant to healthcare professionals on diagnosis, clinical documentation, and medical coding for cholestasis and liver injury. Find details on ICD codes and best practices for accurate clinical charting related to cholestatic liver conditions.
Also known as
Toxic liver disease with cholestasis
Cholestasis caused by drugs or other toxic substances.
Other specified liver diseases
Liver conditions not classified elsewhere, potentially including cholestatic injury.
Other specified diseases of biliary tract
Biliary tract diseases that can sometimes lead to cholestatic liver injury.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the cholestatic liver injury drug-induced?
Yes
Is it due to a specific drug?
No
Is there another known cause?
When to use each related code
| Description |
|---|
| Cholestasis due to drug or toxin exposure. |
| Biliary obstruction causing cholestasis. |
| Primary biliary cholangitis (autoimmune). |
Coding cholestasis without specific type (e.g., drug-induced) leads to inaccurate severity and reimbursement.
Failing to document the causative agent (drug, toxin) for cholestatic liver injury impacts coding and care.
Overlooking co-existing liver conditions (e.g., cirrhosis) affects DRG assignment and quality metrics.
Q: What are the key differentiating features in the differential diagnosis of drug-induced cholestatic liver injury versus other forms of cholestatic liver disease?
A: Differentiating drug-induced cholestatic liver injury (DILI) from other cholestatic liver diseases requires a thorough clinical evaluation. Key features suggesting DILI include a temporal relationship between medication initiation and symptom onset (typically within 1-4 months), absence of other clear etiologies like primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC), and potential resolution of symptoms upon drug discontinuation. Laboratory findings in DILI often reveal elevated alkaline phosphatase (ALP) and bilirubin, with less pronounced aminotransferase elevations compared to hepatocellular injury. Consider liver biopsy for challenging cases, which may show cholestasis, bile duct injury, or portal inflammation. Explore how specific drug characteristics (lipophilicity, dose, metabolism) can contribute to DILI risk. It's crucial to rule out other causes, including viral hepatitis, autoimmune hepatitis, biliary obstruction, and inherited metabolic disorders through appropriate serological tests, imaging, and liver function tests. Learn more about the Roussel Uclaf Causality Assessment Method (RUCAM) for evaluating suspected DILI cases.
Q: How should I manage a patient presenting with suspected drug-induced cholestatic hepatitis, including initial workup and treatment strategies?
A: Managing suspected drug-induced cholestatic hepatitis starts with a detailed medication history, including over-the-counter drugs, herbal supplements, and any recent changes in medication regimen. Promptly discontinue the suspected causative agent. Initial workup involves liver function tests (LFTs), including ALP, bilirubin, ALT, AST, GGT, and INR. Assess for pruritus, jaundice, and other associated symptoms. Consider abdominal ultrasound or other imaging modalities to rule out biliary obstruction. If the cholestasis is severe or prolonged, consider obtaining a liver biopsy to assess the extent of injury and exclude other diagnoses. Treatment focuses on supportive care, including management of pruritus with medications like cholestyramine or ursodeoxycholic acid (UDCA). Closely monitor LFTs for improvement after drug discontinuation. In severe cases, consider referral to a hepatologist for further evaluation and management. Explore implementing a standardized protocol for evaluating suspected DILI within your practice.
Patient presents with signs and symptoms suggestive of cholestatic liver injury. Differential diagnosis includes drug-induced cholestatic hepatitis, toxic liver disease with cholestasis, and other causes of biliary obstruction. The patient reports experiencing pruritus, jaundice, dark urine, and clay-colored stools. Physical examination reveals icteric sclera and skin. Laboratory findings demonstrate elevated alkaline phosphatase, gamma-glutamyl transferase (GGT), and conjugated bilirubin levels. Liver function tests (LFTs), including AST and ALT, may be mildly elevated. Abdominal ultrasound or magnetic resonance cholangiopancreatography (MRCP) may be indicated to rule out biliary obstruction. Patient history includes recent medication use, including [mention specific medications], which may be implicated in the development of drug-induced liver injury. The patient denies excessive alcohol consumption. A thorough medication review and assessment for potential environmental exposures to hepatotoxins are crucial for accurate diagnosis. Initial management includes discontinuation of any potentially hepatotoxic medications. Further investigation may include liver biopsy to assess the extent of liver damage and confirm the diagnosis. Treatment plan focuses on supportive care, symptom management, and monitoring of liver function. Patient education regarding the importance of medication compliance and avoidance of potential hepatotoxins is essential. ICD-10 code K71.1 (Intrahepatic cholestasis) is considered, pending further diagnostic workup. Follow-up appointments are scheduled to monitor liver function and assess response to treatment.