Understanding and Coding Encephalopathy: A Guide for Coders

Encephalopathy refers to brain disease, damage, or malfunction, with the primary symptom of encephalopathy often being altered mental status. Given the variety of types and causes of encephalopathy, coders may find it challenging to determine when and how to code it accurately.

Common Types of Encephalopathy

Here are some of the common types of encephalopathy you might come across:

1. Toxic Encephalopathy (G92.8, G92.9)

• Causes: Exposure to neurotoxic substances, poisoning, or overdose.
• Notes: Often irreversible. Treatment focuses on the cause or symptoms.

2. Metabolic Encephalopathy (G93.41)

• Causes: Lack of glucose, metabolic agents, or electrolyte imbalance (e.g., dehydration, trauma, renal failure, infection).
• Notes: Usually reversible once the underlying metabolic issue is resolved. Septic encephalopathy falls under this code.

3. Toxic Metabolic Encephalopathy (G92.8)

• Causes: Metabolic disturbances including those due to illness, medications or illicit-drugs.
• Notes: No cure, but treatment of underlying causes leads to improvement in symptoms.

4. Anoxic Encephalopathy (G93.1)

• Causes: Brain damage due to lack of oxygen (e.g., cardiac arrest, seizures, severe lung disease).
• Notes: Can be permanent and irreversible depending on the duration of oxygen deprivation.

5. Hepatic Encephalopathy (K76.82)

• Causes: Liver failure or disease.
• Notes: Often reversible with appropriate treatment. . This condition can occur in cirrhosis, acute liver failure, chronic liver disease, hepatitis, etc.

6. Hypertensive Encephalopathy (I67.4)

• Causes: Extremely high blood pressure.
• Notes: Generally reversible with blood pressure management.

7. Acute and Unspecified Encephalopathy (G93.40)

• Causes: Direct brain injury or illness.
• Notes: Specific cause often known but not documented, preventing more specific coding.

8. Other Encephalopathy (G93.49)

• Notes: Used when encephalopathy is secondary to a particular cause/disease without a specific entry under the main term “Encephalopathy” in the ICD-10-CM Alphabetic Index.

Specific Coding Guidelines

• For patients with toxic metabolic encephalopathy and hepatic encephalopathy, both conditions should be coded to reflect the patient's full condition accurately. Toxic encephalopathy is not inherent to hepatic encephalopathy, thus both G92.8 and K76.82 should be used.
• Encephalopathy due to sepsis is coded as G93.41, as there is a specific entry under encephalopathy for septic causes.
• Postictal encephalopathy is not coded separately from the seizure, as it is integral to the seizure event (AHA CC 4Q2013 Page: 89-90). In contrast, static encephalopathy due to epilepsy is a chronic condition and should be coded separately as "other" encephalopathy.

Additional Resources

For detailed coding questions and specific scenarios, refer to the AHA Coding Clinic. This resource contains multiple questions and answers addressing encephalopathy coding, providing further clarity and guidance for accurate coding practices. By understanding the different types of encephalopathy and following these coding guidelines, coders can ensure accurate and comprehensive documentation, ultimately supporting better patient care and compliance with coding standards.

References:

AHA Coding Clinic, Fourth Quarter 2022, Page: 27.

AHA Coding Clinic, Second Quarter 2018 Pages: 22-25

AHA Coding Clinic, Fourth Quarter 2018 Page: 16

AHA Coding Clinic, First Quarter 2021 Page: 13

AHA Coding Clinic, Second Quarter 2021 Pages: 3-4

AHA Coding Clinic, First Quarter 2022 Pages: 52-53

AHA Coding Clinic, Second Quarter 2017 Pages: 8-9

AHA Coding Clinic, Third Quarter 2016 Page: 42

AHA Coding Clinic, Second Quarter 2016 Page: 35

AHA Coding Clinic, Fourth Quarter 2013 Pages: 89-90

AHA Coding Clinic, Fourth Quarter 2009 Pages: 99-101

http://www.medicinenet.com/encephalopathy

https://en.wikipedia.org/wiki/Toxic_encephalopathy

https://en.wikipedia.org/wiki/Hypertensive_encephalopathy

https://en.wikipedia.org/wiki/Hepatic_encephalopathy#Treatment

https://en.wikipedia.org/wiki/Encephalopathy

https://www.biausa.org/public-affairs/media/an-overview-of-toxic-metabolic-encephalopathy-an-acquired-brain-injury

About our Encephalopathy, Altered Mental Status, Dementia, and Delirium Coding in ICD-10-CM Course

In this course, students will gain a deep understanding of the intricate world of medical coding, specifically focusing on the differentiation and accurate coding of encephalopathy, altered mental status, dementia, and delirium diagnoses in the ICD-10-CM coding system. Through in-depth lessons and real-world coding scenarios, participants will learn to decipher the clinical indicators and distinctions among these complex conditions. The course delves into critical aspects of coding guidelines, clinical documentation, and the practical application of codes, ensuring coders are well-equipped to navigate these challenging diagnoses in the healthcare setting.

The information contained in this blog post 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.