Therefore, G92 Toxic encephalopathy is the correct code to report for the diagnosis “toxic metabolic encephalopathy” even though the term “metabolic” is not in the description for code G92. Next, see the instruction “Code first, if applicable,” which applies to codes in both ranges listed – T36-T50 and T51-T65.
Metabolic encephalopathy is never caused by a drug (codes T36-T50) or toxic agent (codes T51-T65). “Toxic metabolic encephalopathy” is a combination of toxic and metabolic factors, a result of infections, the presence of toxins, or organ failure.
The hospital disagreed with the external auditor/payer’s contention that a “T code” for a drug or toxin must always precede code G92 when coding and reporting the diagnosis “toxic metabolic encephalopathy.” Code G92 Toxic Encephalopathy is a Major Complication and Comorbidity (MCC) code.
“Septic encephalopathy” is synonymous with “metabolic encephalopathy.” Metabolic encephalopathy is never caused by a drug (codes T36-T50) or toxic agent (codes T51-T65). “Toxic metabolic encephalopathy” is a combination of toxic and metabolic factors, a result of infections, the presence of toxins, or organ failure.
If you search for toxic encephalopathy, there is the subcategory for metabolic encephalopathy, and both have the code G92. If you look for metabolic encephalopathy, it has the code G93. 41 with the subcategories of drug induced and toxic, both with G92 codes.
Acute toxic-metabolic encephalopathy (TME) is a condition of acute global cerebral dysfunction manifested by altered consciousness, behavior changes, and/or seizures in the absence of primary structural brain disease or direct central nervous system (CNS) infection.
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. Toxic-metabolic encephalopathy describes a combination of toxic and metabolic factors.
ICD-10 code G92 for Toxic encephalopathy is a medical classification as listed by WHO under the range - Diseases of the nervous system .
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].
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).
“Toxic metabolic encephalopathy” is a combination of toxic and metabolic factors, a result of infections, the presence of toxins, or organ failure.
The causes of TME are numerous and varied. Some causes are infections, dehydration, malnutrition, alcohol toxicity, liver/kidney disease, metabolic imbalances, or reduced oxygen to the brain.
Metabolic encephalopathy is usually diagnosed through the blood, urine, and spinal fluid samples. Blood tests may also show if there is an infection or if there are drugs or toxins in the blood. Computed tomography (CT) or magnetic resonance imaging (MRI) may be used to rule out any brain-related problems.
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.
A code from T36-T50 or a code from T51-T65 is not required and sequenced first, ...
If applicable, the query response should specify the drug or toxic agent that caused the TME, in which case a “T” code from T36-T50 or T51-T65 is reported first, followed by G92. If the query response is that the etiology of the TME was not a drug or toxic agent, no “T” code is reported and G92 only is reported for TME.
Code G92 Toxic Encephalopathy is a Major Complication and Comorbidity (MCC) code. MCC codes have the potential of affecting MS-DRG assignment and reimbursement. When MCCs are reported as a secondary diagnosis code, the facility may receive higher reimbursement from a payer than if the MCC code were not present. For this reason, the presence of an MCC code is often targeted and challenged by payers. This is not to imply that the payer’s challenge is meritless or their sole motivation is to reimburse the hospital less.
Coding “toxic metabolic encephalopathy” (TME) Because the term “encephalopathy” is very broad, it is normally preceded in documentation by various terms that describe the reason, cause, or special conditions of the patient that led to the brain malfunction.
Terms defined: “Encephalopathy” can be broadly defined as a global brain dysfunction (brain damage, brain malfunction or brain disease) manifested by an altered mental state that is not due to an underlying neurodegenerative state. The National Institute of Neurological Disorders and Stroke defines “encephalopathy” as follows:
Metabolic encephalopathy is never caused by a drug (codes T36-T50) or toxic agent (codes T51-T65). “Toxic metabolic encephalopathy” is a combination of toxic and metabolic factors, a result of infections, the presence of toxins, or organ failure. When the electrolytes, hormones, or other chemicals in the body are off their normal balance, ...
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 one side, it can be thought that no, you cannot code both because the subcategories in the Official Guidelines for Coding and Reporting lead you to one code for toxic encephalopathy if there is both toxic and metabolic.