ICD-10 Code for Transaminitis: Elevated Transaminases & Unspecified

Getting the diagnosis right on a transaminitis claim takes more than looking up a code. It takes understanding how liver enzyme coding actually works — which ICD-10 CM codes for transaminitis exist, when each one applies, and how the picture changes once a cause has been identified.

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Transaminitis refers to increased transaminases in the liver. In many cases, this increase comes as a surprise, since the patients and doctors themselves did not anticipate it, nor do they know its cause. In fact, this uncertainty is precisely why coding this condition can be a little more complicated than one would think.

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The information in the following section will address the ICD-10-CM codes for transaminitis, along with the most common causes of elevated transaminases in the liver, in order to make your job easier.

What Is Transaminitis and Why Does Coding Specificity Matter?

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There is no separate disease code assigned for transaminitis under ICD-10-CM. "Transaminitis" itself is nothing but a clinical term for high levels of aminotransferase enzymes found in the blood, such as ALT (also known as SGPT) and AST (also known as SGOT). Damage or inflammation in liver cells results in leakage of these enzymes from the cells to the blood, making their presence detectable in a lab panel report.

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In case enzyme levels elevate and stay less than three times the upper limit, then the condition will be described as mild. If it crosses three times but is still less than ten times the upper limit, then it is moderate. In case of a level higher than ten times the upper limit, then it is severe or may be termed as "acute hepatocellular injury." Such classifications help in better diagnosis but have no specific code allocation under ICD-10-CM.

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The Primary ICD-10 Codes for Transaminitis in 2026

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The ICD-10-CM codes for elevated transaminases sit within Category R74 - Abnormal serum enzyme levels

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The key codes within R74, updated through FY2026, are:

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Commonly Accompanying ICD-10 Codes with Transaminitis Diagnoses

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• E11.65 - Type 2 diabetes mellitus with hyperglycemia: The metabolic syndrome and/or insulin resistance has a highly significant association with NAFLD/MASLD, as well as with transaminitis. Codes for the condition should be selected from K76.0 and K75.81 categories.

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• E66.01/E66.09 - Obesity: Obesity plays an important role as one of the causes of fatty liver disease. Codes for the condition should be selected from K76.0 and K75.81 categories.

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• F10.10 - Uncomplicated alcohol use disorder: Whenever the presence of alcoholic hepatitis is determined in a person with alcohol use disorder.

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• Z79.899 - Other long-term (current) drug therapy: In cases where a person has to be on long-term medication therapy resulting in an increased level of transaminases (statins, methotrexate, amiodarone, isoniazid).

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• Z13.220 - Used when there is an accidental elevation of liver enzymes while checking for lipids disorders.

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• R16.0 - Hepatomegaly, not elsewhere classified: If there is a description by the physician of an enlarged liver that may be noted during physical examination and/or imaging of the patient, this code may be used.

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• R16.2 - Hepatomegaly with splenomegaly, not elsewhere classified: When the physician has found hepatomegaly and splenomegaly together with elevated transaminase, then you should choose this one.

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• K76.89 - Other specified diseases of liver: May be used for other specified liver disorders documented by the physician that are not more specifically classified elsewhere in ICD-10-CM.

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Documentation Requirements for Accurate Transaminitis Coding

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The critical issue differentiating between the two categories will, in most cases, revolve around what the doctor has documented in his/her report. For coding queries involving transaminitis visits, consideration must be taken on whether:

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• The elevated enzyme is ALT (SGPT), AST (SGOT), or both. It is critical to note that the physician has to state the name of the specific enzyme either in his/her assessment or plan. In other words, coders make use of the physician's documentation and not by interpretation of lab reports.
• Whether there has been determination of cause. The physician will either be investigating the cause, hence using R74 codes, or already determined the diagnosis (such as NAFLD, drug-induced liver injury, or viral hepatitis).
• Acuity (acute/chronic). It is imperative to indicate here that in contrast to ICD-9-CM, the ICD-10-CM does not have any category separating acute from chronic transaminitis. However, the physician's description of acuity helps in selecting cause codes.
• Drugs and drug-induced injury: In case of suspected or proven drug-induced liver injury, the involved drugs have to be documented by the physician since the K71.x code will have to be used along with the appropriate adverse effect codes (T36–T50.x5).
• Current or former alcohol use: Current or former alcohol use has to be documented for patients that require K70.x codes. A history of alcohol use without current signs of liver disease does not justify using these codes.
• Results of diagnostic imaging studies and biopsies: The results of ultrasonography, CT, MRI, or liver biopsy need to be included in the patient's diagnosis, as "ultrasound reveals fatty infiltration" is enough evidence for K76.0 as opposed to R74.01.
• Liver disease staging: Patients with diagnosed chronic liver disease should also include the degree of fibrosis as well, if this information is available (for example, F2 fibrosis or advanced fibrosis, cirrhosis). In the presence of documented cirrhosis, coding may shift toward cirrhosis-related codes such as K74.60 or K74.61 depending on documentation.

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Coding Errors to Avoid - Transaminitis ICD-10

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• Error 1: If NAFLD, NASH, viral hepatitis, or drug-induced liver injury has already been diagnosed, the definitive condition code should generally be reported instead of R74.01.

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• Error 2: Using R74.9 when there is a mention of the specific enzyme (ALT or AST). Since you know that a doctor specified either ALT or AST, you cannot use an unspecified code. There is R74.01/R74.02, and it is appropriate to use it.

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• Error 3: Using R74.01 code for increased AST in rhabdomyolysis. When rhabdomyolysis is the confirmed cause of AST elevation, M62.82 should generally be the principal diagnosis rather than R74.01.

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• Error 4: Not coding for adverse effect code associated with drug-induced liver injury. K71.x codes often require additional adverse effect or poisoning codes from the T36–T50 range when documentation identifies a causative drug. 

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• Error 5: Old coding descriptions for R74.01. As mentioned earlier, the FY2026 coding description for R74.01 has already been modified. For billing staff members who use EHR systems that are not currently up to date with the current code year, they are using erroneous descriptions.

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How RapidClaims Supports Accurate Transaminitis Coding

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RapidClaims has been designed to provide certainty for coding teams in making decisions for each transaminitis claim.

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This solution integrates intelligent coding assistance into the claim process, where ICD-10 codes are checked against clinical information, the validity of FY2026 codes, and payer coverage guidelines. When it comes to transaminitis or elevated levels of liver enzymes, 

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RapidClaims assists in coding by:

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• Checking if R74.01 should be used, indicating there is a definitive diagnosis and suggesting replacing or upgrading this code with K76.0, K75.81, K71.x, or a viral hepatitis code
• Distinguishing R74.01 from R74.02 based on whether there was AST (SGOT), rather than ALT or transaminases mentioned by the physician
• Raising awareness about adverse effect codes requirement if K71.x is selected without specifying the adverse effect code from T36-T50 series
• Suggesting the latest code descriptions to adhere to, updating the FY2026 codes automatically even if there hasn't been an update to the practice's EHR

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Transaminitis is a clinical diagnosis but not an independent diagnostic category under ICD-10-CM. The choice of ICD-10 code for transaminitis, be it R74.01 (elevation of liver transaminase levels), R74.02 (elevated AST), or other cause-related codes such as K75.81 (NASH) and K71.2 (medication-induced liver injury), must encompass the whole scope of information as known by the treating doctor during his encounter with the patient.

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In cases that occur within specialty practices such as gastroenterology or hepatology, where the patient may come back for follow-up encounters as a diagnosis develops from an abnormal transaminase to fatty liver to NASH to fibrosis, coding of the evolving diagnosis is essential. The first step to document the correct longitudinal information is the ICD-10 code for transaminitis.

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FAQs

Q1. What is the ICD-10 code for transaminitis?

R74.01 is the main ICD-10-CM code used for transaminitis that stands for "elevation of liver transaminase levels". It should be used when the presence of elevated ALT and/or liver transaminases has been noted in the absence of a diagnosed liver pathology.

Q2. What is the ICD-10 code for elevated transaminases?

The ICD-10-CM code for elevated liver transaminases is R74.01. The code refers to the abnormal elevation of liver enzymes (ALT), not specified as due to any underlying liver disease.

Q3. Is there an ICD-10 code specifically for transaminitis unspecified?

There is no diagnostic term "transaminitis unspecified" within the ICD-10-CM. Normally, R74.01 – elevation of liver transaminase levels is applied when documenting elevated transaminases in the absence of an underlying cause.

Q4. When should R74.01 not be used for transaminitis?

One should avoid using R74.01 for reporting transaminitis if there is documentation from the physician that the patient has been diagnosed with liver diseases such as fatty liver disease, NASH, alcoholic hepatitis, or drug-induced liver disease.

Q5. What is the difference between R74.01 and R74.02?

R74.01 is used for elevated liver transaminases (including elevation of ALT), while R74.02 is used when elevation of only AST levels is documented by the provider.