K76.7 ICD-10-CM Code: Hepatorenal syndrome

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for K76.7 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on K76.7 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for K76.7

MedCoder structured workflow — derived from this code’s own official record

Before you code K76.7

1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with K76.7. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the documentation support a condition named in K76.7’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewO90.41, K91.83, R17

Consider K76.7. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

• Excludes1 — check before selecting K76.7(3 notes)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with K76.7: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareO90.41, K91.83, R17

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of K76.7(12 notes)

  Coding workflow: The conditions named in this note are not included in K76.7. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareK70, E85, Q44.6, I82.0, R16.0, E83.110

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (8)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Degeneration, degenerative, hepatorenal
• Failure, failed, hepatorenal
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), cholemic
• Syndrome, hepatorenal
• Syndrome, hepatourologic
• Syndrome, Heyd's
• Syndrome, liver-kidney
• Syndrome, urohepatic

Official Coding Guidelines

No excerpt in the ICD-10-CM Official Guidelines names this code specifically. Its chapter carries only this chapter-wide note:

Don’t confuse K76.7 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of K76.7 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• O90.41— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of hepatorenal syndrome following labor and delivery moves the case to O90.41; the two are not reported together unless documented as unrelated.

  Full comparison: K76.7 vs O90.41 →

• K91.83— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of postprocedural hepatorenal syndrome moves the case to K91.83; the two are not reported together unless documented as unrelated.

  Full comparison: K76.7 vs K91.83 →

• R17— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of jaundice NOS moves the case to R17; the two are not reported together unless documented as unrelated.

  Full comparison: K76.7 vs R17 →

• K76.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Liver disease, unspecified” takes K76.9; specificity in the record moves it back here.

  Full comparison: K76.7 vs K76.9 →

• K70— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of alcoholic liver disease adds K70; it is not part of this code and both may be reported when both are documented.

  Full comparison: K76.7 vs K70 →

• E85— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of amyloid degeneration of liver adds E85; it is not part of this code and both may be reported when both are documented.

  Full comparison: K76.7 vs E85 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name K76.7 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes2 notes: N17 — Acute kidney failure, N17-N19 — Acute kidney failure and chronic kidney disease (N17-N19), N18 — Chronic kidney disease (CKD), N19 — Unspecified kidney failure.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 4 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 441 (MDC 07), DRG 442 (MDC 07), DRG 443 (MDC 07), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):DIG019 — Other specified and unspecified liver disease (default); GEN002 — Acute and unspecified renal failure.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

K76.5 — Hepatic veno-occlusive disease, K76.89 — Other specified diseases of liver, K76.9 — Liver disease, unspecified

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Chronic Liver Failure/End-Stage Liver Disorders) for risk-adjusted payment.

I85.00 — Esophageal varices without bleeding, I85.01 — Esophageal varices with bleeding, I85.10 — Secondary esophageal varices without bleeding, I85.11 — Secondary esophageal varices with bleeding, K70.40 — Alcoholic hepatic failure without coma, K70.41 — Alcoholic hepatic failure with coma, K72.10 — Chronic hepatic failure without coma, K72.11 — Chronic hepatic failure with coma, K72.90 — Hepatic failure, unspecified without coma, K72.91 — Hepatic failure, unspecified with coma, K76.6 — Portal hypertension, K76.81 — Hepatopulmonary syndrome, K76.82 — Hepatic encephalopathy

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Liver Transplant Status/Complications, Coma, Brain Compression/Anoxic Damage, Cirrhosis of Liver, Chronic Hepatitis, Cholangitis and Obstruction of Bile Duct Without Gallstones

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Other specified and unspecified liver disease, Acute and unspecified renal failure).

K75.1 — Phlebitis of portal vein, K75.89 — Other specified inflammatory liver diseases, K75.9 — Inflammatory liver disease, unspecified, K76.0 — Fatty (change of) liver, not elsewhere classified, K76.1 — Chronic passive congestion of liver, K76.2 — Central hemorrhagic necrosis of liver, K76.3 — Infarction of liver, K76.4 — Peliosis hepatis, K76.5 — Hepatic veno-occlusive disease, K76.6 — Portal hypertension, K76.81 — Hepatopulmonary syndrome, K76.82 — Hepatic encephalopathy, K76.89 — Other specified diseases of liver, K76.9 — Liver disease, unspecified, K77 — Liver disorders in diseases classified elsewhere, K91.83 — Postprocedural hepatorenal syndrome, N17.0 — Acute kidney failure with tubular necrosis, N17.1 — Acute kidney failure with acute cortical necrosis, N17.2 — Acute kidney failure with medullary necrosis, N17.8 — Other acute kidney failure, +42 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Degeneration, degenerative”, “Failure, failed”; these codes share that main term but sit in a different category of the Tabular List.

K70.41 — Alcoholic hepatic failure with coma (hepatic, alcoholic, with coma), K71.10 — Toxic liver disease with hepatic necrosis, without coma (hepatic, due to drugs), K71.11 — Toxic liver disease with hepatic necrosis, with coma (hepatic, due to drugs, with coma), K71.9 — Toxic liver disease, unspecified (liver NEC, toxic), K72.00 — Acute and subacute hepatic failure without coma (hepatic, acute or subacute), K72.01 — Acute and subacute hepatic failure with coma (hepatic, acute or subacute, with coma), K72.10 — Chronic hepatic failure without coma (hepatic, chronic), K72.11 — Chronic hepatic failure with coma (hepatic, chronic, with coma), K72.90 — Hepatic failure, unspecified without coma (hepatic), K72.91 — Hepatic failure, unspecified with coma (hepatic, with coma), K86.89 — Other specified diseases of pancreas (pancreas), K90.83 — Intestinal failure (intestinal), K91.82 — Postprocedural hepatic failure (hepatic, postprocedural), L98.8 — Other specified disorders of the skin and subcutaneous tissue (skin), M27.61 — Osseointegration failure of dental implant (dental implant, pre-integration), M27.62 — Post-osseointegration biological failure of dental implant (dental implant, due to, occlusal trauma), M27.63 — Post-osseointegration mechanical failure of dental implant (dental implant, post-osseointegration, mechanical), M27.69 — Other endosseous dental implant failure (dental implant), M51.04 — Intervertebral disc disorders with myelopathy, thoracic region (intervertebral disc, thoracic region, with, myelopathy), M51.05 — Intervertebral disc disorders with myelopathy, thoracolumbar region (intervertebral disc, thoracolumbar region, with, myelopathy), +271 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Gamma-glutamyl Transferase (GGT) Test, Hepatitis Testing, Iron Panel, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of K76.7 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run K76.7 with these 6 related codes in Claim Check

Hierarchy

• K00-K95 — Chapter 11: Diseases of the Digestive System (K00-K95) (K00-K95)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K70-K77 — Diseases of liver[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Excludes1

• K91.83 — Postprocedural hepatorenal syndrome[Excludes1]: “postprocedural hepatorenal syndrome (K91.83)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• O90.41 — Hepatorenal syndrome following labor and delivery[Excludes1]: “hepatorenal syndrome following labor and delivery (O90.41)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• N17 — Acute kidney failure[Excludes2]: “hepatorenal syndrome (K76.7)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• N17-N19 — Acute kidney failure and chronic kidney disease (N17-N19)[Excludes2]: “hepatorenal syndrome (K76.7)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• N18 — Chronic kidney disease (CKD)[Excludes2]: “hepatorenal syndrome (K76.7)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• N19 — Unspecified kidney failure[Excludes2]: “hepatorenal syndrome (K76.7)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• DIG019 — Other specified and unspecified liver disease[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• GEN002 — Acute and unspecified renal failure[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 63 — Chronic Liver Failure/End-Stage Liver Disorders [CMS-HCC]: “Chronic Liver Failure/End-Stage Liver Disorders — supersedes HCC 64 (Cirrhosis of Liver), HCC 65 (Chronic Hepatitis), HCC 68 (Cholangitis and Obstruction of Bile Duct Without Gallstones), HCC 202 (Coma, Brain Compression/Anoxic Damage)”— CMS-HCC V28 · 2026

MS-DRG Grouper

• MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 441 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC[MS-DRG]: “DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 442 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC[MS-DRG]: “DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 443 — DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC[MS-DRG]: “DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC (MDC 07)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 791 — PREMATURITY WITH MAJOR PROBLEMS[MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS[MS-DRG]: “FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 07 — Diseases and Disorders of the Hepatobiliary System and Pancreas[MDC crossing]: “Diseases and Disorders of the Hepatobiliary System and Pancreas — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 2,481 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
• MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Degeneration, degenerative, hepatorenal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Failure, failed, hepatorenal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Nephrosis, nephrotic (Epstein's) (syndrome) (congenital), cholemic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, hepatorenal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, hepatourologic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, Heyd's[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, liver-kidney[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Syndrome, urohepatic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (14)

• K76 — Other diseases of liver[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.0 — Fatty (change of) liver, not elsewhere classified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.1 — Chronic passive congestion of liver[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.2 — Central hemorrhagic necrosis of liver[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.3 — Infarction of liver[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.4 — Peliosis hepatis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.5 — Hepatic veno-occlusive disease[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• K76.6 — Portal hypertension[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 6 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to K76.7 in its code family, with their registry titles.

• K76.2 — Central hemorrhagic necrosis of liver
• K76.3 — Infarction of liver
• K76.4 — Peliosis hepatis
• K76.5 — Hepatic veno-occlusive disease
• K76.6 — Portal hypertension
• K76.8 — Other specified diseases of liver
• K76.81 — Hepatopulmonary syndrome
• K76.82 — Hepatic encephalopathy
• K76.83 — Intestinal failure-associated liver disease
• K76.89 — Other specified diseases of liver

View all codes in the K76 family