ICD-10 K76.81
Billable / Specific HCC v28: 27Hepatopulmonary syndrome
About ICD-10-CM K76.81
ICD-10-CM code K76.81 represents Hepatopulmonary syndrome. This is a billable/specific code in the Digestive System chapter (block K76). The 2026 edition of ICD-10-CM K76.81 became effective on October 1, 2025.
Coding Tips for K76.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
K76.81 is a CMS-HCC v28 risk-adjustment code (category 27). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Coding Notes
Code First
- underlying liver disease, such as:
- alcoholic cirrhosis of liver (K70.3-)
- cirrhosis of liver without mention of alcohol (K74.6-)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for K76.81
Local Coverage Determinations (LCDs) from CMS MACs that list K76.81 as a covered diagnosis.
Showing top 10 of 160 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing K76.81.
1 Cigna
5 Medicare
2 Aetna
CPT Codes Commonly Billed with K76.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert K76.81 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| K76.81 | 5735 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To K76.81
Other codes in section K70-K77 (Diseases of liver).
ICD-10 K76.81, Billing FAQ
Is ICD-10 code K76.81 billable? +
Yes, K76.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does K76.81 affect Medicare Advantage HCC risk adjustment? +
Yes. K76.81 maps to CMS-HCC v28 category 27. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does K76.81 map to? +
Per CMS GEMs, K76.81 maps to ICD-9 codes: 5735. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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