Encephalopathy due to UTI & code G94
Hello, we are experiencing an increase in denials related to encephalopathy due to UTI. Pt meets the clinical criteria for encephalopathy. Per the denial, code G93.4 (for metabolic encephalopathy) has an excludes 1 note excluding encephalopathy in disease classified elsewhere and directs the coder to code G94. G94 provides note to code first underlying disease. In the letter they state "AHA Central Office was consulted which indicated encephalopathy due to other conditions is assigned to code G94, other disorders of brain in diseases classified elsewhere." We are all up in arms wondering which direction to go. Our interim Coding Supervisor has instructed the coding staff not to used code G94 even though encephalopathy or metabolic encephalopathy due to UTI is documented, If this is the case then encephalopathy due to UTI is not a MCC. Please let me know your thoughts. Thanks!
Comments
Sorry.. there is a typo... the supervisor instructed the coders to use G94
When I see the G94 code, I interpret it to be applied to patients with chronic, "static" encephalopathies (ie intractable seizure disorder, chronic metabolic disorders such as glutaric acidemia, genetic disorders affecting the brain, etc). In these cases, the encephalopathy is progressive, not reversible with treatment.
Will be interesting to hear what others say.
Jackie Touch
CHOC Children's, Orange, CA
I do not agree with coding metabolic encephalopathy d/t UTI to G94. We have seen an increase in denials when we have coded this to G93.4 even though the diagnosis is supported clinically. If you crosswalk G94 backwards to an ICD-9 equivalent, it is totally different type of disorder.
If we notice below, all of these conditions involve cerebral degeneration which is a progressive, non-reversible type of condition where structural changes occur. These are the “other disorders of brain in diseases classified elsewhere” that G94 encompasses. Metabolic encephalopathy documented to be d/t things such as fever, infection, electrolyte imbalance, dehydration, acidosis, organ failure etc. should not be classified here. The hallmark with metabolic encephalopathy is that it is reversible and resolves when the underlying condition is corrected and no structural changes occur. ICD-10 CM Code G94 official approximate match mapping between ICD-9 and ICD 10 as provided by the General Equivalency mapping crosswalk:
G94 Equivalent ICD-9 code 331.7
Historical Information for ICD-9 Code 331
331.0 Alzheimer's disease
331.1 Frontotemporal dementia
331.11 Pick's disease
331.19 Other frontotemporal dementia
331.2 Senile degeneration of brain
331.3 Communicating hydrocephalus
331.4 Obstructive hydrocephalus
331.5 Idiopathic normal pressure hydrocephalus (INPH)
331.6 Corticobasal degeneration
331.7 Cerebral degeneration in diseases classified elsewhere
331.8 Other cerebral degeneration
331.81 Reye's syndrome
331.82 Dementia with lewy bodies
331.83 Mild cognitive impairment, so stated
331.89 Other cerebral degeneration
331.9 Cerebral degeneration, unspecified
I agree with the above. Metabolic encephalopathy is not an assumed part of a UTI presentation. It is not integral. It does not fall under the intent of the code for "encephalopathy in diseases classified elsewhere". Why? Because it is not part of the UTI presentation, thus it is not part of the descriptive term "in diseases classified elsewhere" because it is not part of UTI.
The index "encephalopathy in disease classified elsewhere" is for use when the encephalopathy is generally an assumed outcome. Assumed doesn't mean integral either. What happens is in the early stages (of chronic progressive dz processes) there is no encephalopathy (so it is not ALWAYS integral) but as the disease progresses it does in fact become assumed/integral. The way this works: Metabolic causes: rarely assumed to be integral (thus very rarely if ever reported under "in diseases classified elsewhere").
Early stages of chronic degenerative dz process...not integral ..is probably not part of the disease process. (and you likely have a different type of encephalopathy to report).
Late stages: Is integral....but since the patient can present both ways.....you can add the code for "encephalopathy in disease classified elsewhere" to accurately report the status.
Generally what you see here is auditors who are either new, or who are gaming the system. I find they clearly are not understanding the intent of the ICD 10 coding conventions.
I don't work for AMA but I would recommend G32.89: the includes note state "progressive encephalopathy in diseases classified elsewhere".
This is a localized intracranial process and not part of the normal metabolic, toxic, hypertensive, septic, other types of encephalopathy we tend to look for. It is progressive if left untreated.
I also think the commonly recommended G94 "other diseases of the brain" from the ICD 10 indexing is not the most specific code available here (thus my recommendation).
The resources and treatment are the same as treating the underlying hydrocephalus so I have no problem with not getting credit. However that is the same for hypertensive encephalopathy (you just treat the hypertension) but you DO get a CC for hypertensive encephalopathy...All I can say there is.....welcome to CDI!
If the patient continued to have encephalopathy after a shunt you might have justification for going for "other encephalopathy" as it is no longer just part of the symptoms of the NPH.
Feel free to disagree....this stuff is highly subjective some times.