Hepatorenal Syndrome with Acute Kidney Injury (1Q 2025 Coding Clinic)
A patient presents with acute kidney injury (AKI) likely secondary to hepatorenal syndrome (HRS) secondary to metastatic breast cancer to the liver.
Would AKI and HRS be reported separately or is AKI integral to HRS?
Both conditions are reported to accurately reflect the severity of the patient’s condition. Therefore, assign codes: N17.8, Other acute kidney failure and K76.7, Hepatorenal syndrome (Code N17.8 is assigned because the underlying cause of the AKI is documented and code N17.8 best describes the AKI).
In addition, category N17, Acute kidney failure, has an instructional note to “code also associated underlying condition”:
And at section level N17-N19, Acute kidney failure and chronic kidney disease, there is an excludes2 note for HRS; therefore, both codes are assigned:
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