Excludes 1 note with other and unspec. encephalopathy (G93.4)
I am working with insurance and RAC denials and currently have my second denial for the code metabolic encephalopathy, which is well documented. Insurance is saying that the Excludes 1 note "encephalopathy in diseases classified elsewhere (G94)" means that if encephalopathy is due to another diagnosis, that rather than code G93.41 we are to code G94. I, on the other hand, interpret the Excludes 1 note to mean that if you have documentation listed with that excludes note, you use the code listed, not G93.4*.
I would really like to hear any comments you have as maybe I'm not interpreting this correctly.
Thank you.
Linda Haynes (lhaynes@lhs.org)
Comments
Excludes1 means do not code here.
– indicates that the code excluded should never be used at the same time as the code above the Excludes 1 note. It is used when two conditions cannot occur together, such as congenital form vs an acquired form of the same condition.
In the coding handbook it states: Metabolic encephalopathy is temporary or permanent damage to the brain due to lack of glucose, oxygen or other metabolic agent, or 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.