Encephalopathy

donnakellykent@gmail.com

What is the general consensus for criteria for coding encephalopathy? Apparently are coders are getting denials despite the fact that the doctor uses the term several times in the record and describes patients' mental state as very confused.

Thanks,
Donna

katysuegood@gmail.com

Hi Donna,

We have found that it is very important to specify the underlying cause of the encephalopathy so you can avoid the unspecified code. We only receive denials on unspecified encephalopathy  (so far). As for coding, its my opinion that encephalopathy should be coded when stated by the MD. Coders (and CDI) do not get to decide whether the dx is appropriate. If there are not clinical indicators to support the dx, then we can query for clinical indicators (reverse query). But my feeling is that when a provider makes a dx then we either code or clarify, we cannot simply ignore the dx.
 I don't know if you cant the most recent ACDISRadio but it was about encephalopathy. Dr. Pinson did a great job clarifying when encephalopathy should/should not be documented.


Katy

donnakellykent@gmail.com

Thanks Katy. I seem to be in a bit of a battle with the coders regarding your point exactly. I don't question a doctor's documentation unless it is unclear or unsubstantiated.

Thanks again,
Donna

deanne_wilk

Encephalopathy may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital.

 

Encephalopathy may be assigned as a secondary diagnosis if it occurs after admission or if it is present on admission but does not meet the definition of principal diagnosis.

 

Clinical Indicators:

Showing some of the following signs and symptoms:

Altered Mental Status from baseline

Coma

Confusion

Delirium

Disorientation

Lethargic

Psychosis

Restlessness

Stupor

Patient may become more alert when underlying condition is treated or resolved

 

Review medical history for other conditions which may be an underlying etiology of Altered Mental Status such as:

Alzheimer’s disease

Chemical dependencies

CVA or TIA Hx

Medications

Parkinson’s disease

Lewy body dementia

Mood disorders

Schizophrenia

Seizure Hx

Tumors

 

Tests to determine etiology may include but are not limited to:

ABG’s

CT

Cultures

EEG

Laboratory workup

MRI

Toxicology

 

Possible etiologies of encephalopathy include and should be linked to the condition:

Anoxic encephalopathy

Hepatic encephalopathy

Uremic encephalopathy

CVA

Metabolic encephalopathy

PRES (posterior reversible encephalopathy syndrome)

Septic encephalopathy

Toxic encephalopathy

Hypertensive encephalopathy

 

Please include the above clinical indicator documentation within the medical record.  If indicators are not present, findings to support the diagnosis must be documented within the medical record.