by Raquel Shumway
Apr 13th, 2022
Hepatic fibrosis is initiated in the cells of the liver that store fat. These cells produce an excess amount of abnormal tissue (e.g., scar tissue) in the liver. This tissue buildup replaces healthy liver tissue making it difficult for the liver to function properly. This can be caused by chronic injury to the liver. Another possible cause (among several) of Hepatic fibrosis is nonalcoholic steatohepatitis (NASH), which is a disease that causes fat to build up in the liver which can lead to inflammation and fibrosis.
| Advanced fibrosis due to NASH is associated with increased risk of liver-related complications, including liver-related mortality, as well [as] overall mortality. Patients with advanced fibrosis due to NASH also have a reduced quality of life. They have increased risk of liver cancer, and increased risk of hospitalization
ICD-10 Coordination and Maintenance Committee Meeting 2019 |
Codes for different stages of hepatic fibrosis and other inflammatory liver disease(s) were added as of October 1, 2020. These include coding for the different stages of fibrosis.
K74.00 Hepatic fibrosis, unspecified
K74.01 Hepatic fibrosis, early fibrosis (stage F1 or stage F2)
K74.02 Hepatic fibrosis, advanced fibrosis (stage F3)
K76.81 Nonalcoholic steatohepatitis (NASH)
| Classifications for Fibrosis | ||
| NASH CRN classification | Metavir staging system Also includes Activity Grade |
|
| F0 – no fibrosis | F0 – no fibrosis | A0 – no activity |
|
F1 – perisinusoidal or periportal |
F1 – portal fibrosis without septa |
A1 – mild activity |
|
F2 – perisinusoidal and portal/periportal |
F2 – portal fibrosis with rare septa |
A2 – moderate activity |
|
F3 – bridging fibrosis or pre-cirrhosis |
F3 – numerous septa without cirrhosis |
A3 – sever activity |
|
F4 – cirrhosis |
F4 – cirrhosis |
|
Patients are generally diagnosed when they reach End Stage Liver Disease (ESLD) by undergoing a liver biopsy. This creates higher healthcare costs and higher risks of complications and mortality. However, newer non-invasive tests now exist that can help in the assessment and early detection of hepatic fibrosis before it reaches the level of cirrhosis.
Non-invasive tests include:
- Clinical tests/models combined with demographic information and blood tests (see MERCK Manual box below)
- Acoustic technologies such as:
Note: acoustic technologies such as elastography may not be recommended for patients with certain conditions (e.g., pregnancy).
According to the MERCK Manual, blood tests included in clinical models can also be used to diagnose a patient’s level or stage of fibrosis as noted in the following:
| Blood tests are included in clinical models (eg, APRI index, BARD score, FIB-4 score, nonalcoholic fatty liver disease [NAFLD] fibrosis score), which combine commonly available tests (AST, ALT, platelet count, albumin, INR) with demographic and clinical information (eg, age, body mass index [BMI], diabetes/impaired fasting glucose). Some commercially available panels (eg, FibroTest [known as Fibrosure in the US], Hepascore, European Liver Fibrosis panel [ELF]) combine indirect markers (eg, serum bilirubin) and direct markers of hepatic function. Direct markers are substances involved in the pathogenesis of extracellular matrix deposition or cytokines that induce extracellular matrix deposition. These models and panels are best used to distinguish between 2 levels of fibrosis: absent to minimal vs moderate to severe; they do not accurately differentiate between degrees of moderate to severe fibrosis. Therefore, if fibrosis is suspected, one approach is to start with one of these panels and then do the new noninvasive imaging assessments of fibrosis, reserving liver biopsy as a last resort. Lee, TH & Peters, JJ. Jan 2022. Hepatic Fibrosis. www.merckmanuals.com |
References:
Quick, Current, Complete - www.findacode.com