ICD-10 Code E74.4 – Disorders of pyruvate metabolism and gluconeogenesis (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code E74.4 – Disorders of pyruvate metabolism and gluconeogenesis
What it is
E74.4 covers inherited disorders that affect how the body processes pyruvate or makes glucose through gluconeogenesis. These conditions can disrupt normal energy production, especially in tissues with high energy needs.
Clinical signs
Clinical features vary; refer to documentation. Reported findings may include developmental delay, neurologic abnormalities, recurrent lactic acidosis, feeding problems, or failure to thrive, depending on the specific disorder.
When to use this code
Use E74.4 when the provider documents a disorder of pyruvate metabolism, pyruvate dehydrogenase deficiency, or a gluconeogenesis defect. It is also appropriate when the chart identifies a confirmed inherited metabolic disorder in this category. If the record is nonspecific, check documentation before assigning the code.
Do not use for
Do not use this code for general hypoglycemia, nonspecific acidosis, or metabolic abnormalities without a documented pyruvate or gluconeogenesis disorder. Check documentation if the condition is acquired rather than inherited.
Coding tip
Look for the exact metabolic diagnosis in the assessment, not just abnormal labs, before coding E74.4.