K75.4: Autoimmune hepatitis

Risk adjustment

K75.4 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 65 Chronic Hepatitis0.185 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

K75.4 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A56421Billing and Coding: CT of the Abdomen and Pelvis
• A56669Billing and Coding: Hospice - Liver Disease
• A57063Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy
• A57361Billing and Coding: Monitored Anesthesia Care