This document discusses the need for new ICD-10 codes to more specifically capture reasons for elevated liver enzyme tests. It provides two examples of asymptomatic patients with elevated AST, ALT or LDH on routine labs who then require additional testing to determine the underlying cause. Currently, there is only a nonspecific code but the author proposes new codes to separately track abnormal levels of the liver transaminases ALT and AST as well as elevated LDH. This would allow for better tracking of the reasons patients present for evaluation of asymptomatic liver enzyme abnormalities.

1. Elevated Liver
Function Test
Jeffrey Linzer, MD, FAAP, FACEP
American Academy of Pediatrics
Representative to ICD-10-CM/PCS EAB
Professor of Pediatrics and Emergency Medicine
Emory University School of Medicine

2. WHY A NEW CODE?
• Healthy 12 year-old has routine blood tests as part of a
sports physical. Enzymes AST, ALT and LDH come back
elevated. Additional testing is ordered to determine
cause of elevated liver enzymes
▪ AST = aspartate aminotransferase
▪ ALT = alanine aminotransferase
▪ LDH = lactate dehydrogenase
• 4 year-old properly restrained passenger is involved in
a moderate speed vehicle collision. Child has no
physical findings or complaints but routine trauma labs
show elevated AST and ALT. Child now has a CT scan
with IV contrast. Results do not show any injury
tissue
liver

3. WHY A NEW CODE?
• In the first case the only reason for obtaining
additional tests was to determine why the liver
transaminases and LDH were elevated. There
isn’t any other reason for the encounter or lab
tests.
• In the second case elevated AST and ALT have
some predictive value in determining intra-
abdominal injury, e.g. liver laceration. Since there
aren’t any other findings or complaints there is
no other justification for obtaining the CT scan.

4. WHY A NEW CODE?
• In an asymptomatic patient elevated levels alone
could require additional studies looking for
– liver enzymes:
▪ occult neoplasia
▪ occult infection
– LDH
▪ occult neoplasia
▪ occult infection
▪ occult skeletal and cardiac muscle injury
▪ anemia

5. SPECIFIC ENZYME ELEVATION
Current code
• R74.0 Nonspecific
elevation of levels of
transaminase and lactic
acid dehydrogenase [LDH]
Proposed codes
R74.0 Nonspecific elevation of
levels of transaminase and
lactic acid dehydrogenase [LDH]
New code R74.01 Abnormal
levels of liver transaminase
– Add Abnormal levels of alanine
transaminase (ALT)
– Add Abnormal levels of
aspartate transaminase (AST)
New code R74.02 Elevation of
levels lactic acid dehydrogenase
[LDH]