“Encephalopathy is a general term used to describe any disorder of cerebral function. It is a very broad term and in most cases will be preceded by various terms describing the reason, cause or special conditions leading to the brain disorder. Some of the common encephalopathies are noted below:” (3M coding reference)
• Anoxic encephalopathy refers to brain damage due to lack of oxygen. (3M coding reference)
• Alcoholic encephalopathy is a serious complication of alcoholic liver disease usually caused by excessive drinking for several years. It results in a loss of specific brain function (damage of brain tissue) caused by a thiamine deficiency. (3M coding reference)
• Hepatic encephalopathy is brain damage due to liver disease. There are subentries for codes to specifically describe different etiologies and for hepatic failure with or without coma. The default for hepatic failure is without coma. (3M coding reference)
• Metabolic encephalopathy is temporary or permanent damage to the brain due to lack of glucose, oxygen or other metabolic agent, or caused by organ dysfunction. Symptoms include an altered state of consciousness, usually characterized as delirium, confusion, or agitation, and changes in behavior or personality. There may also be symptoms of muscle stiffness or rigidity, tremor, stupor or coma. Symptoms can develop quickly and may resolve when the condition is reversed. Assign code G93.41, Metabolic encephalopathy for this condition. Code G93.41 also includes septic encephalopathy. (3M coding reference)
• Toxic encephalopathy, also known as toxic metabolic encephalopathy, is a degenerative neurological disorder caused by exposure to toxic substances or as an adverse effect of medication. It consists of a variety of symptoms, characterized by an altered mental status, and can include memory loss, small personality changes, lack of concentration, involuntary movements, nausea, fatigue, seizures, arm strength problems and depression. (3M coding reference)
• Wernicke’s encephalopathy involves damage to the central nervous system and the peripheral nervous system and is caused by disorders of the liver such as cirrhosis, hepatitis, malnutrition, and conditions in which blood circulation bypasses the liver entirely. The symptoms can range from mild to severe and consist of various neurological symptoms including changes in consciousness, reflexes and behavior. (3M coding reference)
• Unspecified encephalopathy is assigned to code G93.40, Encephalopathy, unspecified. (3M coding reference)
At Mercy, the physicians are documenting “Toxic Metabolic Encephalopathy” without consistently linking the diagnosis to a causative agent. Our coders are unable to pick up the diagnosis without further specification documented in the record.
• In the coding world, Toxic metabolic encephalopathy is also known as toxic encephalopathy and differs from metabolic encephalopathy.
• When using the term Toxic or Toxic Metabolic Encephalopathy you must link the diagnosis to a causative agent, medication or unknown substance. Ex. Toxic or Toxic Metabolic Encephalopathy due to opioid poisoning.
• Metabolic Encephalopathy can be associated with Sepsis, other infections, dehydration or other metabolic or organic condition. Ex. Metabolic encephalopathy due to UTI and dehydration.
• Hepatic encephalopathy requires additional specification of acuity. Ex. Acute, acute on chronic or chronic hepatic encephalopathy due to cirrhosis.
Reference:: American Hospital Association (2017). 3m Coding reference 1-10 coding handbook