ICD code K76.0 – Fatty liver, not elsewhere classified

Key Takeaways

K76.0 covers simple hepatic steatosis and nonalcoholic fatty liver (NAFL) without inflammation: not alcoholic fatty liver, not NASH (K75.81), and not fibrosis (K74.0).

Alcohol etiology must be explicitly excluded in the physician note before K76.0 can be assigned: missing this step is the top cause of payer audits and denials.

When the physician documents steatohepatitis with lobular inflammation or hepatocyte ballooning, K75.81 applies instead of K76.0, even if the patient has no alcohol history.

Pabau’s integrated ICD-10-CM code library and claim scrubbing tools flag K76.0 vs K70.0 conflicts before submission, reducing the documentation gap that drives most denials.

ICD-10 code K76.0: Definition and code hierarchy

ICD-10 code K76.0 is the official ICD-10-CM code for “Fatty liver, not elsewhere classified,” effective for discharges and encounters billed under the current fiscal year’s code set maintained by the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services. It is a full 4-character billable code, not a header code, and may be used as a principal or secondary diagnosis.

The CDC/NCHS ICD-10-CM browser lists K76.0 under the inclusion terms “nonalcoholic fatty liver” and “hepatic steatosis.” These are the two clinical presentations this code is designed to capture. Any coder working a gastroenterology, hepatology, or primary care claim involving NAFLD without documented steatohepatitis should default here unless an exclusion applies.

Included conditions and clinical scenarios

K76.0 covers fat accumulation in the liver when no alcohol etiology is present and when the pathology has not progressed to steatohepatitis. The following presentations map correctly to this code.

• Nonalcoholic fatty liver (NAFL): Simple steatosis confirmed on imaging or biopsy, without lobular inflammation, hepatocyte ballooning, or fibrosis.
• Incidental hepatic steatosis on imaging: When an abdominal ultrasound, CT, or MRI identifies echogenic liver suggestive of steatosis and the physician documents “fatty liver” or “hepatic steatosis” as a diagnosis.
• NAFLD without steatohepatitis: A documented NAFLD diagnosis where the clinical record does not indicate progression to NASH (no elevated inflammatory markers consistent with hepatocellular injury, no biopsy showing ballooning).
• Metabolic-associated fatty liver without inflammation: Fatty liver in the context of obesity, type 2 diabetes, or hyperlipidemia, where the treating physician’s note documents simple steatosis only.

The physician’s documentation is the gating factor. If the note says “fatty liver” or “hepatic steatosis” and alcohol is excluded, K76.0 is correct. If it says “steatohepatitis,” “NASH,” or references elevated transaminases with hepatocellular injury, K75.81 applies instead.

Excludes notes and code conflicts

The K76 category carries exclusion notes that are compliance-critical. Assigning K76.0 when an excluded condition is present is an Excludes1 violation, meaning the codes are mutually exclusive and cannot appear on the same claim.

K76.0 vs K75.81: Fatty liver vs nonalcoholic steatohepatitis

K75.81 (nonalcoholic steatohepatitis, NASH) is the correct code when the physician documents hepatic inflammation alongside fat accumulation. K76.0 applies only to the simpler end of the NAFLD spectrum, where fat is present but no hepatocellular injury has occurred.

The clinical distinction matters: NAFL (K76.0) carries a low risk of progression and is often managed with lifestyle changes alone. NASH (K75.81) involves active liver injury and may require a liver biopsy to confirm. If the NONALCOHOLIC FATTY LIVER DISEASE Activity Score (NAS) on biopsy shows ballooning degeneration or lobular inflammation, the correct code shifts to K75.81. Coders cannot make this determination themselves. The physician must explicitly document the diagnosis; use whichever code matches the documented diagnosis, never the inferred one.

Documentation requirements for a fatty liver ICD-10 code diagnosis

Payer medical necessity reviews for K76.0 focus on three elements: An explicit physician diagnosis, objective evidence of steatosis, and documented exclusion of alcohol etiology. Missing any one of these is the starting point for a denial. Good medical billing compliance starts at the note level, not the claim level.

• Explicit diagnosis statement: The physician’s note must state “fatty liver,” “hepatic steatosis,” “nonalcoholic fatty liver disease,” or “NAFLD” as a confirmed diagnosis, not merely a differential or impression. “Rule out fatty liver” does not support K76.0.
• Imaging or biopsy findings: Documentation of ultrasound echogenicity consistent with steatosis, MRI-PDFF result, or liver biopsy showing fat infiltration ≥5% of hepatocytes (without steatohepatitis features) provides the objective anchor.
• Alcohol etiology excluded: The note should document negative alcohol use history or state that the fatty liver is “nonalcoholic” or “non-alcoholic” in etiology. Without this, payers may challenge the K76.0 assignment and request K70.0 review.
• Relevant comorbidities documented: Obesity (E66.x), type 2 diabetes (E11.x), or hyperlipidemia (E78.x) support medical necessity and are typically co-coded. Document them in the same encounter note.

The AAPC’s ICD-10-CM code lookup cross-references K76.0 with its inclusion terms. When in doubt, run the physician note against those inclusion terms before assigning the code.

Commonly co-coded diagnoses

NAFLD rarely presents in isolation. The ICD-10-CM codes most frequently assigned alongside K76.0 reflect the metabolic syndrome context in which the condition appears. Obesity documented with no stated type or cause is reported as ICD-10 code E66.9.

When elevated liver enzymes (transaminitis) are documented in an encounter where NAFLD is confirmed, code K76.0 first. The elevated enzyme codes (R74.01, R74.02) are secondary because the underlying condition is now known. Coding only the symptom code when a confirmed diagnosis is in the note is a common sequencing error that invites queries.

Payer requirements and prior authorization

Medicare and most commercial payers do not require prior authorization for K76.0 as a diagnosis code itself, but they do scrutinize the services billed alongside it. Liver ultrasound (CPT 76700), hepatic function panels (CPT 80076), and hepatology evaluation and management codes must all be supported by medical necessity documentation tied to K76.0.

Submit claims electronically and confirm eligibility before each encounter. Pabau integrates with electronic claims via Claim.MD, Pabau’s US clearinghouse partner, covering more than 4,000 payers including Medicare and Medicaid. Real-time eligibility checks run before the patient arrives, reducing the documentation surprises that cause K76.0 claims to pend. For a grounding in medical billing fundamentals that underpin every K76.0 submission, the linked guide covers the full revenue cycle context.

• Medicare: K76.0 is an accepted secondary diagnosis code for hepatology services. The Local Coverage Determination (LCD) for the specific service (e.g., liver ultrasound) must list K76.0 or a related code in its covered ICD-10 list. Verify the applicable LCD on the CMS Medicare Coverage Database before billing.
• Medicaid: Coverage varies by state. Some state Medicaid programs require prior authorization for hepatology specialist visits; check the payer portal before the encounter, not after.
• Commercial payers: Most follow AHA Coding Clinic guidance and accept K76.0 without PA for outpatient evaluation. Inpatient admissions require clear documentation of why the fatty liver warranted hospital-level care.

Common claim denial reasons and how to avoid them

K76.0 denials cluster around three root causes: Wrong code (K70.0 should have been used), insufficient documentation, and K76.0 assigned when K75.81 was clinically indicated. Sound denial management workflows catch these before submission.

Claim scrubbing that checks ICD-10-CM edit pairs catches the K76.0/K70.0 Excludes1 conflict before the claim reaches the payer. Submitting a clean claim means every code on the claim has been validated against the current-year edit tables and the physician documentation in the same workflow step.

See how Pabau handles ICD-10 coding accuracy

Pabau’s integrated ICD-10-CM library and Claim.MD clearinghouse connection flag code conflicts like K76.0 vs K70.0 before submission. Book a demo to see claim scrubbing in action.

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ICD-10-CM to ICD-9-CM crosswalk

Providers reconciling legacy records, handling retroactive billing, or working with payers that cross-reference ICD-9-CM data should note that K76.0 maps to ICD-9-CM code 571.8 (Other chronic nonalcoholic liver disease) according to commonly referenced crosswalk tables, though the mapping should be verified against the official CMS General Equivalence Mapping (GEM) forward and backward files before use in any billing context.

*The ICD-9-CM GEM mapping is listed here as commonly referenced but is marked as uncertain in the research basis for this article. Verify against the official CMS GEM files before using this crosswalk in any billing reconciliation.

How practice management software supports accurate coding

The documentation failures that drive K76.0 denials – missing alcohol exclusion, ambiguous NAFL vs NASH language, symptom codes sequenced ahead of confirmed diagnoses – are all preventable at the point of note capture and claim preparation. Practice management platforms that embed ICD-10-CM logic into the clinical workflow close these gaps before a claim is submitted.

Pabau’s claims management software integrates an ICD-10-CM code library with claim scrubbing that checks edit pairs, including the K76.0/K70.0 Excludes1 conflict, before electronic submission via Claim.MD. For clinics managing metabolic health patients with fatty liver as a recurring secondary diagnosis, Pabau’s metabolic health EMR features structured encounter templates that prompt for alcohol etiology documentation and imaging reference at every relevant visit. That means the physician note arrives at the coder’s queue with the three elements payers require already in place.

The revenue cycle benefit compounds over time: A practice running 50 K76.0 claims per month that eliminates the top two denial reasons (K70.0 conflict, missing alcohol exclusion) through workflow automation avoids the administrative cost of working those denials repeatedly. For more on closing those loops across the full revenue cycle, see our guide to revenue cycle management for specialty practices.

Conclusion

K76.0 is a precise code for a specific clinical presentation: Simple hepatic steatosis without alcohol etiology and without steatohepatitis. The denials come from treating it as a catch-all fatty liver code rather than applying the three-step logic the ICD-10-CM Tabular demands.

Pabau’s integrated claims workflow checks K76.0 edit pairs and links documentation prompts to encounter templates, so coders and clinicians work from the same structured note rather than chasing documentation after the claim has already been denied. To see how this works across your metabolic health caseload, explore the revenue cycle management guide or speak with our team about configuring the K76.0 workflow for your practice.

Continue your research

Need a clearinghouse that handles K76.0 claim edits automatically? Claim.MD integration overview explains how Pabau routes ICD-10 claims through real-time edit checks across 4,000+ US payers.

Confused by denial codes on your K76.0 claims? Denial codes in medical billing breaks down the CARC and RARC codes most commonly returned on liver disease claims.

Looking for the documentation standard your hepatology team should follow? Medical billing compliance guide covers the documentation requirements that keep metabolic disease codes audit-ready.

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