Seizure and encephalopathy
I am looking for advice on the coding of seizures and encephalopathy. Our coders have indicated that if a patient is admitted for seizures and also has a diagnosis of encephalopathy, the encephalopathy should not be reported as an MCC due to the fact that encephalopathy is "inherent" in seizure.
I have not been able to find a Coding Clinic that supports this assumption, but perhaps I am missing something. Anyone out there have insight into this?
Thanks,
Robin
Robin Van Vught, RN
Clinical Documentation Specialist
Meriter Hospital
608-417-7593
rvanvught@meriter.com
.
I have not been able to find a Coding Clinic that supports this assumption, but perhaps I am missing something. Anyone out there have insight into this?
Thanks,
Robin
Robin Van Vught, RN
Clinical Documentation Specialist
Meriter Hospital
608-417-7593
rvanvught@meriter.com
.
Comments
The CC below supports coding encephalopathy along with epilepsy. I would presume the same advice applies to ‘seizures’ which, if recurrent, would be coded to epilepsy. Hope this helps -
Admission for evaluation and initiation of ketogenic diet
Coding Clinic, Third Quarter 1997 Page: 5 Effective with discharges: August 1, 1997
Related Information
Question:
A 5 year old child was admitted to the hospital for evaluation and initiation of a ketogenic diet. The patient has been diagnosed as having myoclonic encephalopathy and psychomotor developmental delay. He has responded fairly well to Depakote prior to admission, but he was still having intermittent myoclonic seizures. The record states he was admitted electively for initiation of ketogenic diet. What should the principal diagnosis code be?
Answer:
Note from 3M:
As of October 1 2000, code 783.4 has been expanded to the fifth digit level for further specification.
Note from 3M:
As of October 1, 2003, code 348.3 has been expanded to the fifth digit level for further specification.
Assign code 345.1, Generalized convulsive epilepsy, for the myoclonic seizures, as the principal diagnosis. However, if the physician states that the patient has familial or progressive myoclonic seizures, assign code 333.2, Myoclonus. In addition, assign code 348.3, Encephalopathy, unspecified, for the myoclonic encephalopathy; and code 783.4, Lack of expected normal physiological development for the psychomotor developmental delay.
© Copyright 1984-2012, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.
Sharon Salinas, CCS
Barlow Respiratory Hospital
213-250-4200 Extension 3336
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
And disagree with your coding staff... Now days, if you wake up after the seizure (depending on the cause)... you are likely not even be admitted as an inpatient. You would go home for outpt workup.
Enceph could have been caused by another condition and may have been metabolic or even toxic in nature. Whatever caused the enceph may have also caused seizure. I am not aware of a coding clinic that supports "not coding" the enceph. Enceph is always caused by something else. Seizures and Enceph can both be symptoms of the same underlying condition or both could be caused by two unrelated conditions. No way inherent! (And before even going down that route, I would want clarification from the MD that the seizure actually caused the enceph. Sounds more like an assumption.)
This article may help... Brian Murphy's White paper regarding Enceph. The article can be viewed by clicking on the link below.
http://www.hcpro.com/content/235239.pdf
Vicki S. Davis, RN CDS
Clinical Documentation Improvement Manager
Health Information Management Department
Alamance Regional Medical Center
Office (336) 586-3765
Ascom Mobile (336) 586-4191
Fax (336) 538-7428
vdavis2@armc.com
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug."- Samuel "Mark Twain" Clemens
Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.637.9002
Fax: 415.600.1325
Ofc: 415.600.3739
evanspx@sutterhealth.org
ran...as well as whether the coders were confusing a postictal state
with encephalopathy.
Yes, postictal state is inherent to a seizure. Encephalopathy is not
and I believe one with a good clinical insight can reasonably
differentiate between the two.
Is there one physician (or several) that are using the term
encephalopathy to describe the condition for many/most seizure patients
when really just postictal?
As CDS's, we need to carefully use our judgement on when there is
something significantly 'different' about the patient's described
condition, return to baseline, or additional resources, treatment or
evaluation aimed at an altered mental status. Additionally, was there
some clinical insult (perhaps hypoxia, metabolic or electrolyte
abnormalities due to prolonged seizure state) that might lean more
toward an encephalopathy vs normal seizure recovery.
Don
Jane
See an abstract on pub-med from 1990 that describes the condition
http://www.ncbi.nlm.nih.gov/pubmed/2345618
Also on pub-med from 1992
http://www.ncbi.nlm.nih.gov/pubmed/1422175
Another brief reference from 2005:
http://www.ncbi.nlm.nih.gov/books/NBK7305/
There does not seem to be very much out there in the literature (based
on a casual search) so I am not certain how widely this state either
occurs or how broadly it is accepted. For that significantly prolonged
period perhaps this is a useful diagnosis. From the brief readings, I'd
say the time period is likely at least 24 hours if not 36 hours, but I
have not read any of the original articles (just skimmed the
abstracts).
One of the alternative causes that needs to be investigated is if there
is continued seizure activity in the brain.
Don
Thank you for your reply. I did look at those sources. Good information for me.
-Jane
I realize this thread is a bit old but I am currently dealing with the issue of coding/not coding postictal encephalopathy. I feel that the 2013 Coding Clinic below is instructing NOT to add a code for the encephalopathy. Any thoughts/comments would be appreciated.
Seizure with encephalopathy due to postictal state, Coding Clinic, 4th Quarter 2013, p. 89-90
Question: The patient is a 70-year-old female who presented to the emergency department (ED) because of mental status change. While in the ED, she had a tonic-clonic seizure that was witnessed by staff. The patient had no previous history of seizure and was admitted as an inpatient for further evaluation and management. In the discharge summary, the provider noted, "On admission the patient had mental status changes, which subsequently resolved. Consequently, we have determined that the patient had encephalopathy secondary to postictal state." Should encephalopathy be reported as an additional diagnosis with seizure when it's due to a postictal state? Would the encephalopathy be considered inherent to the seizure or can it be separately reported?
Answer: Assign code 780.39, Other convulsions, as the principal diagnosis. The encephalopathy due to postictal state is not coded separately since it is integral to the condition. Seizure activity may be followed by a period of decreased function in regions controlled by the seizure focus and the surrounding brain. The postictal state is a transient deficit, occurring between the end of an epileptic seizure and the patient's return to baseline. This period of decreased functioning in the postictal period usually lasts less than 48 hours.I was always taught not to code, and have had outside auditors agree, if within that “normal” postictal period. I always looked to validate the dx of encephalopathy if it extended time, additional resources started being extended beyond our facilities norm, etc..
might be worth revisiting the topic with coding clinic.
Jeff