K72.90 ICD-10-CM Code: Hepatic failure, unspecified without coma
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the digestive system (K00-K95) / Diseases of liver (K70-K77)
K72.90
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHepatic failure, unspecified without coma
Severe liver failure of unknown duration or type where the liver cannot perform its vital functions, but the patient remains conscious.
Buddy Insight
Unspecified hepatic failure without coma represents severe liver dysfunction where the timeline and specific etiology are unclear but cognitive function is preserved.
CMS-HCC V28
MappedHCC 63
RAF 0.307
CMS-HCC V24
MappedHCC 27
RAF 0.910
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 27
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for K72.90 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for K72.90 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for K72.90 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for K72.90 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for K72.90 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for K72.90 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for K72.90 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 K72.90 an HCC code?
Yes. K72.90 maps to End-Stage Liver Disease under the CMS-HCC V28 risk adjustment model (and End-Stage Liver Disease under V24).
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.
MEAT Criteria for K72.90
For K72.90to 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 K72.90 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
K72.90 is the ICD-10-CM diagnosis code for hepatic failure, unspecified without coma. Severe liver failure of unknown duration or type where the liver cannot perform its vital functions, but the patient remains conscious. K72.90 sits in the ICD-10-CM chapter for diseases of the digestive system (k00-k95), within the section covering diseases of liver (k70-k77).
Under the CMS-HCC V28 risk adjustment model, K72.90 maps to End-Stage Liver Disease (HCC 63) with a community, non-dual, aged base RAF weight of 0.307. Under the older V24 model, K72.90 mapped to the same category but with a base RAF weight of 0.910, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use this code only when the chronicity (acute vs. chronic) cannot be determined from documentation. Because K72.90 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for K72.90 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the chronicity (acute vs. chronic) cannot be determined from documentation
- •Query the provider if additional information is available to specify acute versus chronic hepatic failure
Clinical Significance
Unspecified hepatic failure without coma represents severe liver dysfunction where the timeline and specific etiology are unclear but cognitive function is preserved. This condition still carries high mortality risk requiring intensive evaluation and management.
Documentation Requirements
- ✓Documentation of hepatic failure diagnosis
- ✓Absence of coma or encephalopathy noted
- ✓Lack of specific timeline or etiology documentation
- ✓Laboratory evidence of liver failure
- ✓Assessment of liver synthetic function
- ✓Evaluation for underlying causes
- ✓Treatment plan for liver failure
- ✓Transplant evaluation consideration