ICD-10 Code for Transaminitis: A Complete Coding Guide

An abnormal liver enzyme result might look simple on a lab report. Figuring out the right code for that result isn’t always easy. One term that often causes confusion is transaminitis.

Transaminitis usually means higher than levels of liver enzymes called alanine aminotransferase and aspartate aminotransferase. It is a sign that something’s wrong, with the liver but it is not a specific disease. This difference is important when writing down what happened and picking the ICD-10-CM code.

For providers accurate coding helps make it clear why extra testing, monitoring, imaging or treatment might be needed. It also helps reduce confusion when a payer reviews whether liver-related lab services were medically necessary.

This guide explains the ICD-10 code, for transaminitis. It includes diagnosis codes. You will also find documentation tips. The guide covers testing codes. It points out mistakes that providers should avoid when coding.

What Is the ICD-10 Code for Transaminitis?

The ICD-10-CM code commonly used when the provider documents elevated liver transaminase levels is R74.01  Elevation of levels of liver transaminase levels.

CMS lists R74.01 as the diagnosis code, for liver transaminase levels while the official description includes elevation of ALT and AST.

ICD-10-CM Code	Description	Common Use
R74.01	Elevation of levels of liver transaminase levels	Elevated ALT and/or AST
R74.02	Elevation of levels of lactic acid dehydrogenase [LDH]	Elevated LDH
R74.8	Abnormal levels of other serum enzymes	Other specified elevated serum enzymes
R74.9	Abnormal serum enzyme level, unspecified	Abnormal enzyme when no specific enzyme is documented
R94.5	Abnormal results of liver function studies	Abnormal liver function study when appropriately documented

CMS treats these as diagnoses under the serum enzyme and liver-function finding categories.

When looking at a patients record that shows high ALT and high AST levels or elevated liver enzymes the code R74.01 is used when there is no clear cause found. This code works best for situations where the liver enzymesre not normal but no specific reason has been identified yet.

What Does Transaminitis Mean?

Transaminitis is a clinical term used to describe elevated transaminase enzymes in the bloodstream.

The two liver enzymes most commonly associated with the term are:

ALT — Alanine Aminotransferase

ALT is found predominantly in the liver. An elevated ALT level may occur when liver cells become irritated or damaged.

AST — Aspartate Aminotransferase

AST is present in the liver as well as other tissues, including skeletal muscle and the heart. Therefore, AST elevation does not automatically confirm liver disease.

An abnormal ALT or AST result means the healthcare provider should consider looking into the patient’s condition. It does not by itself show what the actual problem is.

That’s why transaminitis should not be recorded as hepatitis, fatty liver disease, cirrhosis or any other liver condition unless the doctor has clearly written that diagnosis. Just because someone has liver enzymes does not mean they have a liver disease.

Is Transaminitis a Disease?

Not usually.

Transaminitis is generally seen as a lab result or a clinical sign, not a diagnosis.

A patient can have transaminase levels for many reasons, such, as metabolic liver disease, medications, infection, alcohol use, hard exercise, muscle injury or other hidden problems.

For example imagine the lab report shows ALT and AST. The doctor orders tests and imaging but still does not know the cause.

At that moment the code R74.01 might correctly describe the documented problem.

If later tests point to a disease that explains the enzyme rise the coding must show the doctor’s final diagnosis following ICD‑10‑CM rules and payer rules.

Why Correctly Coding Elevated Liver Enzymes Matters

A small difference in documentation can lead to a very different coding outcome.

Consider these three notes:

ALT and AST elevated.

This supports an abnormal transaminase finding and may point to R74.01.

Abnormal liver studies.

Depending on the complete documentation, a broader abnormal liver-function finding may be more appropriate.

Elevated enzymes due to metabolic dysfunction-associated steatotic liver disease.

The established liver diagnosis may need to be coded rather than relying only on the abnormal laboratory finding.

This is why copying an ICD-10 code from a laboratory report without reviewing the provider’s assessment can cause problems.

The diagnosis should reflect what is actually documented for that encounter.

R74.01 vs. R74.8: What Is the Difference?

These codes are sometimes confused.

R74.01 — Elevated Liver Transaminase Levels

Use this code when documentation specifically identifies increased liver transaminase levels, such as elevated:

• ALT
• AST
• SGPT
• SGOT

R74.01 is therefore generally the more specific choice for documented transaminitis.

R74.8 — Abnormal Levels of Other Serum Enzymes

R74.8 is used for levels of other specified serum enzymes not the liver transaminases that R74.01 covers.

The Centers for Medicare & Medicaid Services or CMS separates R74.01, from R74.8 in its ICD-10-CM coding guidelines and coverage documents.

Using the specific code that matches what is recorded in the medical record often gives a better understanding of the patient’s health situation.

R74.01 vs. R94.5

Another code that can cause confusion is R94.5 – results of liver function studies.

The difference depends on the way things are written down.

If the doctor clearly says that the ALT or AST levels are high then R74.01 is the choice to describe that result.

If the file only says that liver function tests were not normal but does not say which parts were high then another code, for a finding might be needed based on what is written.

Do not pick codes just because they look similar. The exact words used in the notes are important.

Common Causes of Elevated ALT and AST

Transaminitis has a broad differential diagnosis. Elevated liver enzymes may appear in patients with:

Metabolic Liver Disease

Fat accumulation in the liver may contribute to persistent ALT or AST elevation.

Viral Hepatitis

Hepatitis viruses can cause inflammation and substantially increase liver enzyme levels.

Alcohol-Related Liver Injury

Alcohol exposure may alter liver enzymes, sometimes with AST elevation that is more prominent than ALT.

Medication-Related Liver Injury

Prescription medications, over-the-counter medications, herbal products, and supplements may contribute to liver enzyme abnormalities.

Biliary Disorders

Gallbladder and bile duct conditions can also produce abnormalities across liver-related laboratory tests.

Autoimmune Disorders

Autoimmune liver diseases may present with elevated liver enzymes and require further serologic evaluation.

Muscle Injury

Because AST is found outside the liver muscle damage can increase AST levels even if the liver is not the cause.

The reason should never be guessed just because a lab result is high. Coding must match the diagnosis or problem that the doctor actually wrote down.

Related ICD-10-CM Codes Providers May Encounter

Transaminitis can occur alongside a wide variety of conditions. Depending on the clinical findings and confirmed diagnosis, related ICD-10-CM categories may include:

Code	Description
R74.01	Elevation of levels of liver transaminase levels
R74.02	Elevation of levels of lactic acid dehydrogenase
R74.8	Abnormal levels of other serum enzymes
R74.9	Abnormal serum enzyme level, unspecified
R17	Unspecified jaundice
R16.0	Hepatomegaly, not elsewhere classified
R10.11	Right upper quadrant pain
R94.5	Abnormal results of liver function studies

Some of these codes are also recognized in CMS coverage information for hepatic-function testing.

However, related codes should not be added simply because they commonly occur with elevated enzymes. Each diagnosis must be supported by the patient’s medical record.

CPT Codes Commonly Associated With Transaminitis Evaluation

ICD-10-CM codes explain why a service may be performed. CPT codes generally describe what service or test was performed.

A patient, with liver enzymes may undergo several laboratory services depending on the clinical situation.

CPT 80076 — Hepatic Function Panel

CPT 80076 represents the hepatic function panel.

CMS identifies the panel as including measurements such as:

• Albumin
• Total bilirubin
• Direct bilirubin
• Alkaline phosphatase
• Total protein
• ALT
• AST

CPT 84460 — ALT

CPT 84460 is used for an alanine aminotransferase test.

CPT 84450 — AST

CPT 84450 represents an aspartate aminotransferase test.

CMS includes both 84460 and 84450 as components of the hepatic function panel.

CPT 80053 — Comprehensive Metabolic Panel

Documentation Tips for Transaminitis

Strong documentation makes coding easier and helps establish why additional evaluation is medically necessary.

Instead of documenting only:

Abnormal labs

A provider can be more clinically descriptive:

ALT and AST remain elevated compared with previous testing. Patient denies recent alcohol use. Medication list reviewed. Will repeat hepatic function testing and evaluate for possible underlying liver disease.

The second entry gives considerably more context.

Useful documentation may include:

• Which liver enzymes are elevated
• Whether abnormalities are new or persistent
• Relevant symptoms
• Medication and supplement history
• Alcohol history when clinically relevant
• Previous liver test results
• Relevant medical conditions
• Planned laboratory evaluation
• Imaging orders
• Follow-up plan
• Confirmed or suspected cause, when clinically appropriate

The goal is not to document for a code. The goal is to accurately describe the clinical picture so that the code naturally follows the record.

Coding Transaminitis When the Cause Is Known

A common mistake is continuing to code only R74.01 after a definitive liver condition has been established.

Suppose a patient initially presents with elevated ALT and AST.

During the first encounter:

Assessment: Elevated liver enzymes; etiology unclear.

R74.01 may reasonably describe the finding.

Further testing later establishes a specific liver disease.

At subsequent encounters, the confirmed condition may become the more clinically meaningful diagnosis, depending on the purpose of the visit and official coding rules.

The abnormal enzyme code should not automatically replace a documented definitive diagnosis.

Coding Transaminitis When the Cause Is Unknown

Not every patient with elevated liver enzymes receives an immediate diagnosis.

Providers frequently evaluate unexplained laboratory abnormalities over several visits.

When testing has identified elevated ALT or AST but the underlying cause remains undetermined, documenting the actual abnormal finding is appropriate.

For example:

Assessment: Persistent elevation of ALT and AST. Etiology remains unclear. Repeat hepatic function panel ordered.

In this situation, R74.01 clearly communicates why further liver evaluation is being performed.

This approach is generally more accurate than assigning an unconfirmed liver disease merely to make the claim appear more specific.

Common Transaminitis Coding Mistakes

Using an Unspecified Code When Documentation Is Specific

If the physician clearly documents elevated ALT and AST, using R74.9 for an unspecified enzyme abnormality may lose useful specificity.

R74.01 directly identifies elevated liver transaminase levels.

Coding a Disease That Has Not Been Diagnosed

An abnormal ALT result does not automatically mean the patient has hepatitis, cirrhosis, or fatty liver disease.

The medical record must support the diagnosis being reported.

Coding From the Laboratory Report Alone

Laboratory values provide clinical information, but code selection should align with the provider’s documented assessment and applicable coding rules.

Confusing ALT/AST Elevation With Other Enzyme Abnormalities

R74.01 is specifically associated with liver transaminase elevation. Different abnormalities may require R74.02, R74.8, or another diagnosis code.

Ignoring the Reason for Follow-Up Testing

If additional testing is ordered, the note should clearly explain why.

CMS emphasizes that providers are responsible for selecting ICD-10-CM codes to the highest level of specificity appropriate for the service rendered.

Clear documentation makes that process far easier.

How Transaminitis Can Affect Medical Billing

The coding challenge does not always end once the correct diagnosis code is identified.

Laboratory claims may still be affected by:

• Medical-necessity requirements
• Diagnosis-to-procedure compatibility
• Frequency limitations
• Duplicate testing
• Panel-versus-individual-test billing
• Missing physician orders
• Payer-specific coverage policies
• Insufficient documentation

A practice might have a clinical reason for ordering hepatic testing but still face a denial if the diagnosis submitted does not clearly match the documented reason for the test.

For practices dealing with repeated issues, on lab claims or liver-related claims Utah Billing Service can assist. They help providers review coding workflows claim requirements and documentation patterns that could be leading to denials.

Example of Correct Transaminitis Coding

Consider a patient whose annual laboratory testing reveals:

• ALT: elevated
• AST: elevated
• Bilirubin: normal
• Alkaline phosphatase: normal

The patient has no established liver diagnosis.

The physician documents:

Elevated liver transaminases. Medication list reviewed. Will repeat hepatic function panel and evaluate for metabolic and viral causes.

A reasonable ICD-10-CM code based on that documentation would be:

R74.01 – Elevation of levels of liver transaminase levels

If additional testing later identifies a specific disease, the coding approach may change to reflect the confirmed condition.

Can R74.01 Support Liver Function Testing?

R74.01 is recognized in CMS coverage information associated with hepatic function testing.

However, the appearance of a diagnosis code in a CMS article does not mean every test is automatically covered in every situation.

Coverage may depend on factors such as:

• The patient’s clinical condition
• The test ordered
• Frequency
• Medicare Administrative Contractor requirements
• Other payer policies
• Medical necessity
• Documentation

Practices should verify the applicable payer policy instead of assuming that a diagnosis guarantees reimbursement.

Final Thoughts

The most important part of transaminitis coding is understanding that an abnormal enzyme result is not automatically a definitive liver diagnosis.

For documentation specifically describing elevated ALT or AST, R74.01 – Elevation of levels of liver transaminase levels is the primary ICD-10-CM code to consider. More general or different laboratory abnormalities may require another code, while a confirmed underlying condition can change the coding approach entirely.

Accurate coding starts with specific clinical documentation: identify the abnormal enzymes, document what is known about the cause, explain the next step in evaluation, and avoid assigning diagnoses that have not been established.

For healthcare organizations that need additional support connecting clinical documentation with clean claims, Utah Billing Service can assist providers with medical billing, coding workflows, denial follow-up, and revenue-cycle processes while allowing the clinical team to remain focused on patient care.

FAQs About the ICD-10 Code for Transaminitis

What is the ICD-10 code for transaminitis?

The ICD-10-CM code commonly used for documented transaminitis or elevated ALT/AST is R74.01 – Elevation of levels of liver transaminase levels.

Is transaminitis the same as elevated liver enzymes?

Transaminitis specifically refers to elevations in transaminase enzymes, particularly ALT and AST. “Elevated liver enzymes” can be a broader description because other liver-related enzymes may also be abnormal.

What is the ICD-10 code for elevated ALT?

When elevated ALT is documented as a liver transaminase abnormality, R74.01 is the relevant ICD-10-CM code.

What is the ICD-10 code for elevated AST?

Elevated AST documented as elevated liver transaminase levels may also be coded with R74.01.

Can R74.01 be used for both elevated ALT and AST?

Yes. The official description for R74.01 includes elevations of liver transaminase levels, including ALT and AST.

Is transaminitis the same as hepatitis?

No. Transaminitis describes elevated transaminase levels. Hepatitis refers to liver inflammation and may have a specific underlying cause. Elevated liver enzymes alone should not automatically be coded as hepatitis.

What CPT code is used for liver function testing?

One commonly used code is CPT 80076, which represents the hepatic function panel. The panel includes ALT and AST along with several other hepatic laboratory measurements.