It’s a related mechanism to encephalopathy in a septic patient, which by the way, does code to metabolic encephalopathy. I am not sure if the authors of the Coding Clinic on this issue even considered the full pathophysiology, but I think Coding Clinic is clear that in the absence of any other metabolic problems, G93.49 is the code to use.
Additionally, the physician should give a sentence or two explaining their choice of metabolic encephalopathy when it is only due to a localized infection and document that the metabolic encephalopathy is being mediated by metabolic disruptions because of inflammatory mechanisms.
If more than one type/cause of encephalopathy is documented, more than one code should be reported to fully capture the patient’s diagnosis Even with the documentation and queries sent for clarification of the diagnosis of encephalopathy, denials are still coming in.
Encephalopathy, unspecified. A functional and/or structural disorder of the brain caused by diseases (e.g. Liver disease, kidney disease), medications, chemicals, and injuries. Degenerative diseases of the brain.
Whenever “metabolic encephalopathy” is documented, code G93. 41, Metabolic encephalopathy, should be assigned.
Acute toxic-metabolic encephalopathy (TME), which encompasses delirium and the acute confusional state, is an acute condition of global cerebral dysfunction in the absence of primary structural brain disease [1].
The admission is five days long and the final diagnosis is encephalopathy due to polypharmacy with a metabolic component due to UTI. If toxic encephalopathy (encephalopathy due to drug) is sequenced as the principal diagnosis, metabolic encephalopathy as a secondary diagnosis will act as an MCC.
If you look for metabolic encephalopathy, it has the code G93. 41 with the subcategories of drug induced and toxic, both with G92 codes. On the other hand, it can also be looked at as yes, you can code both. Again, from the Official Guidelines, code G93.
Hepatic encephalopathy: This happens if liver disease causes toxins to build up in a person's blood. Toxic metabolic encephalopathy: This occurs when toxic chemicals, or a chemical imbalance caused by an infection, affects brain function.
There are two major types of metabolic encephalopathies, namely those due to lack of glucose, oxygen or metabolic cofactors (which are usually vitamin-derived) and those due to peripheral organ dysfunction (Table 38-1).
ICD-10-CM Code for Encephalopathy, unspecified G93. 40.
Metabolic encephalopathy has been associated with acute insults such as DKA, but importantly, the risk of cerebral injury is also related to chronic hyperglycaemia. Mechanisms of cerebral injury in diabetes mellitus continue to be investigated.
The guidance provided from Coding Clinic is that “encephalopathy” secondary to a CVA/stroke is not inherent to a CVA/stroke, and as such it should be coded separately with code G93. 49, Other encephalopathy.
Toxic encephalopathy describes acute mental status alteration due to medications, illicit drugs, or toxic chemicals. Metabolic encephalopathy is caused by any of a large number of metabolic disturbances.
Metabolic encephalopathy. This happens when another health condition, such as diabetes, liver disease, kidney failure, or heart failure, makes it hard for the brain to work. For example, if blood sugar gets too high in diabetes, it can lead to confusion and even a coma.
It is a general term and means brain disease, brain damage or malfunction. The primary symptom that is seen in the healthcare record is altered mental status. There are many different types and causes of encephalopathy and at times it is difficult to know if it should be coded and if so what code should be reported.
Indexed in ICD-10-CM to G92 is caused by exposure to neurotoxic substance, poisoning or OD and can be caused by everyday products that we use. Treatment is geared towards the cause or the symptoms. This type of encephalopathy is most often irreversible.
Indexed in ICD-10-CM to G93.41 (there are also entries for drug induced and toxic) is caused by lack of glucose, metabolic agent or electrolyte imbalance. An electrolyte imbalance can be cause by a large number of conditions including, dehydration, trauma, renal failure, and infection. Treatment is geared towards the cause or the symptoms and is most often reversible once the metabolic issue is corrected.
Coding Tip: Encephalopathy. Encephalopathy is a diagnosis that coders see a lot these days. It is a general term and means brain disease, brain damage or malfunction. The primary symptom that is seen in the healthcare record is altered mental status.
Indexed in ICD-10-CM to G93.40 is caused by either a direct injury to the brain or an illness. Most times, the cause is known but not documented by the physician for coders and no further specific code can be assigned.
The diagnosis of hepatic encephalopathy does not mean “coma” is always present. In order for a coder to report that this is with coma, the MD would need to document as such. This is a possibly reversible condition with the appropriate treatment and compliance with the treatment.
Other and unspecified encephalopathy 1 A disorder characterized by a pathologic process involving the brain. 2 A disorder of the brain that can be caused by disease, injury, drugs, or chemicals. 3 A functional and/or structural disorder of the brain caused by diseases (e.g. Liver disease, kidney disease), medications, chemicals, and injuries. 4 Degenerative diseases of the brain.
neoplasms ( C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified ( R00 - R94) Diseases of the nervous system. Clinical Information. A disorder characterized by a pathologic process involving the brain. A disorder of the brain that can be caused by disease, injury, drugs, or chemicals.
This list below causes are not the only causes, but the common causes that coders see.
There are many symptoms associated with encephalopathy, but there is one symptom that is present in all types and that is altered mental status. Coders cringe when they see that documented as well.
Treatment will vary depending on the type and/or cause of the encephalopathy. Here are some of the most common treatments:
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.