<b><i>Introduction:</i></b> Accurate identification of patients with cirrhosis is important for research using administrative databases. We aimed to examine the accuracy of several major ICD-10 codes for cirrhosis diagnosis in a large and diverse patient cohort; there is little existing research on this topic. <b><i>Methods:</i></b> Using data from 3,396 patients with chronic liver disease (hepatitis B or C or nonalcoholic fatty liver disease) from 1 university and several community medical centers, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value, and area under the receiver operating characteristic curve (AUROC) for several major ICD-10 codes for cirrhosis, which was verified by individual chart review. We performed a secondary validation in a general cohort of 1,560 randomly selected patients. <b><i>Results:</i></b> While each of the individual study ICD-10 codes were specific (98.08–100%), none of the codes were sufficiently sensitive (0.27–55.70%). PPVs were high in the chronic liver disease cohort (88.41–100%) but lower in the general population (55.53–66.76%). The AUROC for having at least 1 code was higher (0.79) than any code alone (0.50–0.65). <b><i>Discussion/Conclusion:</i></b> Individual ICD-10 codes are suboptimal for identifying patients with cirrhosis in the general patient population. We recommend conditioning ICD-10 code searches with a chronic liver disease diagnosis code and/or combining diagnostic codes to maximize performance.