B17.11 ICD-10-CM Code: Acute hepatitis C with hepatic coma
HCC Buddy Code Card
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Viral hepatitis (B15-B19)
B17.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute hepatitis C with hepatic coma
This is a severe form of hepatitis C infection that has developed suddenly and is so serious that it has caused the liver to fail, resulting in a coma (loss of consciousness). This is a life-threatening condition requiring immediate medical intervention.
Buddy Insight
Acute hepatitis C with hepatic coma represents fulminant hepatic failure from newly acquired hepatitis C infection, a rare but catastrophic presentation requiring ICU-level care and potential liver transplant evaluation.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 55
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for B17.11 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for B17.11 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for B17.11 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for B17.11 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for B17.11 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for B17.11 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for B17.11 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is B17.11 an HCC code?
No. B17.11 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work B17.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for B17.11
For B17.11to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed B17.11 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
B17.11 is the ICD-10-CM diagnosis code for acute hepatitis c with hepatic coma. This is a severe form of hepatitis C infection that has developed suddenly and is so serious that it has caused the liver to fail, resulting in a coma (loss of consciousness). This is a life-threatening condition requiring immediate medical intervention. B17.11 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering viral hepatitis (b15-b19).
B17.11 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Maps only to RxHCC 55 (Substance Use Disorder, Mild) with RAF 0.0. Despite being a life-threatening condition, this code does NOT map to any V28 or V24 community HCC. The lack of community HCC mapping is a notable gap given the clinical severity of fulminant hepatic failure.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for B17.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code should only be used when hepatitis C is documented as acute (newly acquired) AND hepatic coma is present; do not use if only acute hepatitis C without coma is documented
- •Hepatic coma (also called hepatic encephalopathy) must be explicitly documented by the physician; verify the clinical documentation supports both the acute hepatitis C diagnosis and the presence of coma before assigning this code
Clinical Significance
Acute hepatitis C with hepatic coma represents fulminant hepatic failure from newly acquired hepatitis C infection, a rare but catastrophic presentation requiring ICU-level care and potential liver transplant evaluation. This is one of the most severe presentations of acute viral hepatitis.
Documentation Requirements
- ✓Evidence of acute (newly acquired) hepatitis C infection with seroconversion timeline
- ✓Hepatic coma/hepatic encephalopathy explicitly documented by the provider with staging (West Haven criteria)
- ✓Liver function tests showing acute hepatic failure pattern
- ✓Coagulation studies: INR/PT documenting synthetic function failure
- ✓Level of consciousness assessment and ICU admission documentation
Commonly Confused Codes
- •B17.10 (Acute hepatitis C without hepatic coma): Same acute infection but without the hepatic coma component
- •B19.21 (Unspecified viral hepatitis C with hepatic coma): Use when acute vs. chronic status is unknown; B17.11 requires documented acute infection
- •K72.00 (Acute and subacute hepatic failure without coma): Hepatic failure code that does not specify viral etiology