Cirrhosis of the Liver J017

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: K70.3, K71.7, K74.3- K74.6

Brief description

Cirrhosis of the liver is a chronic liver disease characterised by severe fibrosis with the formation of regenerative nodules, resulting from long-standing injury to the hepatic parenchyma. It represents the end stage of many chronic liver diseases and may lead to progressive loss of liver function and complications of portal hypertension. 

Confirming the diagnosis

Diagnosing cirrhosis involves a clinical presentation and investigations suggesting advanced chronic liver disease. This requires a practitioner's assessment of the patient's history, examination findings, laboratory abnormalities and imaging features consistent with cirrhosis. 

To confirm the diagnosis, evidence of severe hepatic fibrosis with regenerative nodules is required. In many cases, the diagnosis can be established from characteristic clinical, laboratory and radiological findings, including ultrasound, CTor MRI. Transient elastography (Fibroscan) may provide supportive evidence of advanced fibrosis. Liver biopsy remains the histological gold standard but is not routinely required where the diagnosis is otherwise well established. 

Assessment and management generally involve a gastroenterologist or hepatologist, although appropriately experienced general physicians and GPs may confirm the diagnosis when supported by consistent clinical and investigative findings.

Additional diagnoses covered by SOP

• Alcohol-associated cirrhosis
• Biliary cirrhosis
• Cryptogenic cirrhosis
• Primary biliary cholangitis with cirrhosis
• Post- hepatitic cirrhosis
• Secondary biliary crirrhosis

Conditions not covered by SOP

The SOP does not apply to chronic liver diseases that have not progressed to cirrhosis, including:

• Chronic hepatitis without cirrhosis *
• Hepatic fibrosis without cirrhosis #
• Steatohepatitis *

* another SOP applies

# non- SOP condition 

Clinical onset

Clinical onset refers to the earliest point at which cirrhosis, rather than the underlying chronic liver disease, can reasonably be identified. As cirrhosis represents advanced hepatic fibrosis with regenerative nodule formation, earlier symptoms or evidence of chronic liver disease does not constitute the clinical onset of cirrhosis. In most cases, clinical onset corresponds to the first objective evidence of cirrhosis on imaging and/or clinical evidence of established cirrhosis (e.g. portal hypertension or hepatic decompensation). 

Clinical worsening

When assessing clinical worsening, it is important to evaluate whether deterioration exceeds the expected natural progression of cirrhosis. This is very challenging for this condition, as most chronic liver conditions continue to slowly deteriorate. Clinical worsening may be reflected by a significant reduction in hepatic synthetic function, increasing portal hypertension, or the development of complications such as ascites, hepatic encephalopathy, variceal haemorrhage or hepatocellular carcinoma. 

Appropriate management depends on the underlying cause and stage of disease and may include treatment of the causation of the liver disorder, management of complications, and liver transplantation in selected patients. Although early cirrhosis may stabilise or partially regress following successful treatment of the underlying cause, advanced cirrhosis is generally irreversible. Assessment by a hepatologist or gastroenterologist is important when considering whether there has been true clinical worsening.