Elevated Liver Function Tests (LFTs), also known as abnormal liver enzymes or increased liver function tests, can indicate underlying liver conditions. This article explores the clinical significance of elevated LFTs in healthcare, including diagnosis, documentation, and relevant medical coding terms for accurate clinical records. Learn about the causes and implications of elevated liver enzymes and how this information is used in medical coding and billing.
Also known as
Abnormal findings of liver function tests
Indicates abnormal results from liver function tests.
Diseases of liver
Covers various liver diseases that can cause elevated LFTs.
Viral hepatitis
Includes viral hepatitis, a common cause of abnormal liver enzymes.
Poisoning by drugs, medicaments and biological substances
Includes drug-induced liver injury, which can elevate LFTs.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is there a known cause for the elevated LFTs?
When to use each related code
| Description |
|---|
| Elevated liver enzymes, indicating liver dysfunction. |
| Fatty liver disease, excessive fat accumulation in the liver. |
| Liver cirrhosis, late-stage scarring of the liver. |
Coding elevated LFTs without specific enzyme results (e.g., ALT, AST, ALP) lacks specificity, impacting reimbursement and data analysis. Consider CDI query for clarification.
Failing to code the underlying cause of elevated LFTs (e.g., alcohol abuse, hepatitis) leads to incomplete clinical picture and inaccurate risk adjustment.
Distinguishing between transient and chronic LFT elevation is crucial. Incorrect coding impacts patient management and future treatment plans.
Q: What is the most effective differential diagnosis approach for persistently elevated liver function tests (LFTs) in asymptomatic patients?
A: Persistently elevated LFTs in asymptomatic patients require a systematic approach to differential diagnosis. Begin by repeating the LFT panel to confirm the persistent elevation and rule out pre-analytical errors. Consider the magnitude of the elevation: mild increases may warrant watchful waiting with repeat testing, whereas significant elevations necessitate further investigation. A thorough patient history, including medication use (e.g., statins, acetaminophen), alcohol consumption, travel history, family history of liver disease, and risk factors for viral hepatitis, is crucial. Non-alcoholic fatty liver disease (NAFLD) is a common cause and should be considered, particularly in patients with metabolic risk factors. Further investigations may include serological tests for viral hepatitis (A, B, C), autoimmune markers (e.g., ANA, ASMA, AMA), iron studies, ceruloplasmin, and alpha-1 antitrypsin levels. Imaging studies like ultrasound or transient elastography can help assess liver structure and fibrosis. If initial investigations are inconclusive, consider referral to a hepatologist for further evaluation, including liver biopsy if necessary. Explore how risk stratification can guide the diagnostic workup in asymptomatic patients with elevated LFTs.
Q: How can I differentiate between alcoholic fatty liver disease (AFLD) and non-alcoholic fatty liver disease (NAFLD) when evaluating elevated LFTs in a patient with a history of moderate alcohol consumption?
A: Differentiating AFLD from NAFLD in patients with moderate alcohol intake and elevated LFTs can be challenging. While alcohol consumption history is important, it's not solely diagnostic. Both conditions can present with similar LFT patterns, often showing elevated AST and ALT, with AST/ALT ratio sometimes (but not always) greater than 2 in AFLD. A detailed history regarding the quantity and frequency of alcohol consumption is vital. Consider tools like the AUDIT-C questionnaire to assess alcohol use disorders. Imaging, such as ultrasound or MRI, can reveal steatosis but can't reliably differentiate between the two conditions. Liver biopsy remains the gold standard for distinguishing AFLD and NAFLD, revealing specific histological features. However, it's invasive and not always necessary. Serum markers like GGT and MCV may be elevated in AFLD. Ultimately, the diagnosis often relies on a combination of clinical findings, imaging, laboratory data, and excluding other causes of liver disease. Consider implementing validated questionnaires for alcohol use assessment in your practice. Learn more about the role of transient elastography in evaluating liver fibrosis in suspected AFLD/NAFLD.
Patient presents with elevated liver function tests (LFTs), also documented as abnormal liver enzymes or increased liver function tests. Initial evaluation includes a comprehensive review of systems, focusing on symptoms such as fatigue, jaundice, abdominal pain, nausea, vomiting, dark urine, and pale stools. Physical examination may reveal hepatomegaly, splenomegaly, or ascites. Differential diagnosis includes a broad spectrum of hepatic conditions, including viral hepatitis, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), drug-induced liver injury (DILI), autoimmune hepatitis, and biliary obstruction. Laboratory testing will include a complete metabolic panel (CMP) to assess liver enzyme levels (AST, ALT, ALP, GGT), bilirubin, albumin, and coagulation studies. Further investigations may include serological testing for viral hepatitis, imaging studies such as ultrasound, CT scan, or MRI of the abdomen, and potentially liver biopsy if clinically indicated. Initial management focuses on identifying the underlying cause of the elevated LFTs. Treatment plans will be tailored to the specific etiology and may include lifestyle modifications such as weight loss, dietary changes, and alcohol cessation, pharmacotherapy targeted at the underlying disease process, or referral to a specialist for advanced management. Patient education regarding the importance of follow-up appointments and monitoring of LFTs is crucial. ICD-10 coding will be determined based on the final diagnosis. CPT coding for procedures and services provided will be documented accordingly.