Encephalopathy, unspecified
Kennedy says that if a patient's altered mental status (dementia, delirium, or psychosis) can be explained by a named brain disease such as Parkinson's disease or Alzheimer's disease, then the term “encephalopathy” is integral to these diseases unless it is explicitly documented that the altered mental status differs ...
ICD-10-CM Code for Encephalopathy, unspecified G93. 40.
Q: I would like to add encephalopathy due to urinary tract infection (UTI) to our quick coding tips. Coding Clinic instructs coding professionals to code as G93. 49, other encephalopathy, which is now a CC.
Encephalopathy is a term used for any diffuse disease of the brain that alters brain function or structure. The hallmark of encephalopathy is “altered mental status,” a clinical symptom not a diagnosis.
When encephalopathy is the principal diagnosis, the UTI can be added as a CC. When the encephalopathy is a principal diagnosis, auditor denials are not the issue; the real concern is with the documentation not supporting it as a reportable condition.
F02. 8* Dementia in other specified diseases classified elsewhere.
Young children, individuals older than 65 years, and those with pre‐existing dementia or brain injury are particularly susceptible to toxic‐metabolic encephalopathy.
Acute encephalopathy and delirium are clinically similar, but for coding purposes, very different. Delirium is a low-weighted symptom; encephalopathy is a serious, high-weighted medical condition. Delirium is usually due to an underlying encephalopathy, and clinicians should document as such if clinically present.
According to 2020 Centers for Medicare and Medicaid Services definitions,2 toxic encephalopathy (G92), metabolic encephalopathy (G93. 41) and coma (R40) are designated as “major complication or comorbidity” (MCC), whereas unspecified encephalopathy (G93. 40) is designated as “complication or comorbidity” (CC).
Delirium and acute encephalopathy are essentially 2 different terms describing the same condition. Delirium represents the mental manifestation while encephalopathy identifies the underlying pathophysiologic process.
The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are progressive loss of memory and cognitive ability, subtle personality changes, inability to concentrate, lethargy, and progressive loss of consciousness.
Table 1: West-Haven Criteria for Hepatic Encephalopathy (HE)StageConsciousnessNeurologic Findings1Mild lack of awarenessImpaired addition or subtraction; mild asterixis or tremor2LethargicObvious asterixis; Slurred speech3Somnolent but arousableMuscular rigidity and clonus; Hyperreflexia4ComaDecerebrate posturing1 more row
F02.80 describes the manifestation of an underlying disease, not the disease itself. This block comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, ...
The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. Alzheimer's ( G30.-)
A: It’s a common misconception that encephalopathy has only one definition. Encephalopathy can be either metabolic/transient or chronic/progressive/degenerative. There’s no one definition which describes all types of encephalopathy. Let’s look at some examples below: 1 Metabolic 2 Septic 3 Toxic 4 Alcoholic 5 Hypoxic 6 Infectious 7 Ischemic 8 Uremic 9 Structural 10 Wernicke’s 11 Hypertensive
Encephalopathy categories that are unlikely to be fully corrected include: Alcoholic. Ischemic. Structural. Wernicke’s. Remember, though, that this is just a rough approximation and there is likely to be some variation in a patient’s response to treatment even within these two broad categories.
Encephalopathy can be either metabolic/transient or chronic/progressive/degenerative. There’s no one definition which describes all types of encephalopathy. Let’s look at some examples below: Metabolic. Septic. Toxic. Alcoholic. Hypoxic. Infectious.