Hepatorenal syndrome

Hepatorenal syndrome (HRS) is a severe and often fatal complication of advanced liver disease, characterized by progressive renal failure in the absence of primary kidney pathology. It involves a functional impairment of the kidneys due to extreme vasoconstriction of the renal arteries, driven by circulatory changes in end-stage liver disease.

Assign this code for spontaneous hepatorenal syndrome occurring in patients with chronic liver disease, such as cirrhosis or acute liver failure. Documentation should clearly indicate a diagnosis of HRS not attributed to obstetric complications or recent surgical/procedural interventions.

• Differentiate from acute kidney injury (AKI) due to other causes; HRS is a diagnosis of exclusion.
• Review documentation carefully to rule out postprocedural or obstetric-related HRS, which have specific Excludes1 codes.
• Always sequence the underlying liver disease as the primary diagnosis when applicable, followed by HRS.