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v1.0.0
ICD-10 Guide
DiagnosesAcute Renal Failure

Acute Renal Failure

ICD-10 Coding for Acute Renal Failure(N17.0, N17.2, N17.9)

PRIMARY SPECIALTYNephrology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Acute Renal Failure?
Essential facts and insights about Acute Renal Failure

Key Clinical Considerations:

  • Acute decrease in kidney function, typically defined as an increase in serum creatinine by 0.3 mg/dL or more within 48 hours, or an increase in serum creatinine to 1.5 times baseline within the prior 7 days.
  • Laboratory findings may include elevated serum creatinine, elevated blood urea nitrogen (BUN), and electrolyte imbalances such as hyperkalemia.
  • Physical examination may reveal signs of fluid overload, such as edema, hypertension, or altered mental status.
  • Imaging studies like ultrasound may show renal enlargement or obstruction, while CT scans can identify structural abnormalities.
  • Severity criteria include staging based on the Kidney Disease: Improving Global Outcomes (KDIGO) classification, which categorizes acute renal failure into stages based on serum creatinine levels and urine output.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must document the onset of acute renal failure, including the timeline of symptoms and laboratory results.
  • Specific terminology such as 'acute kidney injury' (AKI) or 'acute renal failure' should be used consistently.
  • Examples include documenting the patient's baseline renal function, the acute change, and any interventions initiated.
  • Medical necessity documentation should include the rationale for testing and treatment, especially if inpatient admission is required.
  • Quality measures may require documentation of urine output monitoring and the management of electrolyte imbalances.

Coding Guidelines

Usage Guidelines & Examples

  • Use N17.0 for acute kidney failure, N17.2 for acute kidney failure due to specific causes, and N17.9 for unspecified acute kidney failure.
  • Do not use these codes for chronic kidney disease or end-stage renal disease, as they are distinct diagnoses.
  • Related codes include N18 for chronic kidney disease and N19 for unspecified kidney failure, which should not be confused with acute conditions.
  • Common errors include misclassifying acute renal failure as chronic; ensure to review patient history and lab results.
  • In complex cases, consider the underlying cause of acute renal failure (e.g., prerenal, intrinsic, postrenal) to select the most accurate code.

Code Exclusions

Important Exclusions

  • Excludes chronic kidney disease (N18) and end-stage renal disease (N18.6), as these are not acute conditions.
  • Alternative codes for excluded conditions include N19 for unspecified kidney failure.
  • Conditions are excluded to ensure accurate representation of acute versus chronic renal impairment.
  • Common mistakes include coding acute renal failure when the patient has chronic kidney disease; review history carefully.
  • Related but distinct conditions include acute tubular necrosis (N17.1) and prerenal azotemia.

Related ICD-10 Codes

Primary Codes
N17.0
Acute kidney failure, unspecified
N17.2
Acute kidney failure due to other specified causes
N17.9
Acute kidney failure, unspecified
Ancillary Codes
E86.0
Differential Codes
N17.9
N17.9
when no specific type of acute kidney failure is documented.
N17.0
N17.0
when tubular necrosis is specifically documented.
N17.2
N17.2
when medullary necrosis is specifically documented.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Nephrology

Specialty Applications

  • Applies to patients with sudden onset of renal impairment due to various causes, including dehydration, sepsis, or nephrotoxic agents.
  • Patient populations include all ages, with increased risk in the elderly, those with pre-existing kidney disease, or those undergoing major surgery.
  • Clinical settings include inpatient hospital admissions, emergency departments, and outpatient nephrology clinics.
  • Specialty-specific applications are relevant in nephrology, critical care, and emergency medicine.
  • Treatment contexts include management of fluid status, electrolyte imbalances, and potential dialysis initiation.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with acute renal failure based on elevated serum creatinine and clinical presentation.'

Template 2

Template: 'Clinical presentation consistent with acute kidney injury including oliguria and elevated BUN.'

Template 3

Template: 'Diagnostic criteria met as evidenced by a serum creatinine increase of 0.5 mg/dL within 24 hours.'

Template 4

Template: 'Treatment plan initiated for acute renal failure with fluid resuscitation and electrolyte monitoring.'

Template 5

Template: 'Follow-up care for acute kidney injury including regular monitoring of renal function and urine output.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Documentation must include the patient's baseline renal function, the acute change in serum creatinine, and any relevant clinical findings.

How does this differ from similar diagnoses?

Acute renal failure is characterized by a rapid decline in kidney function, whereas chronic kidney disease is a gradual loss of function over time.

What are common billing considerations?

Ensure that the diagnosis is supported by clinical documentation and that medical necessity is clearly established for inpatient admissions.

What procedures are typically associated?

Commonly associated procedures include dialysis, renal ultrasound, and laboratory tests for kidney function.

Are there any quality reporting implications?

Quality measures may include monitoring of renal function and management of complications such as hyperkalemia.