Hepatic Encephalopathy

Padawan5773Padawan5773
in Clinical & Coding

One of our physicians has documented acute hepatic encephalopathy... Hepatic encephalopathy codes to hepatic failure (it used to give us a CC in ICD 9, now gives us nothing), however with the word 'acute' it codes out to acute hepatic failure which is an MCC, which it really isn't clinically, because that would assume it is on the same level as shock liver.  So what do you really code?  Anyone else having the same issue?

Comments

  • lprescott1lprescott1
    Interesting question- I think I might speak to clarify the acuity- and explain how the code assignment will fall. I see the word acute (within the code set) more describing the function or lack there of the liver- not necessarily describing the encephalopathy where-as the provider is likely speaking to the onset of the encephalopathy. I think this warrants both provider education and a discussion. It is one of those circumstances in which the "medical speak" cannot be accurately captured by the "coder speak"
  • Padawan5773Padawan5773
    Thanks Laurie,

    I think this became more of a problem with the ICD-9 to ICD-10 code shifting.  Hepatic encephalopathy was hepatic encephalopathy, no matter whether the provider documented acute or chronic, but now it codes to hepatic failure which really isn't reflective of the "encephalopathy" portion as I think you were eluding to.  They wanted to capture the encephalopathy as being acute with the sudden elevation in ammonia levels, but the liver failure as we know is a chronic condition with alcoholism or hepatitis...  Coding clinic perhaps? 
  • afrady@blr.comafrady@blr.com

    I have not been recommending the use of acute liver failure in encephalopathic patients unless you were to see a sudden spike in the liver enzymes such as ALT/AST bilirubin etc. I do not believe the ammonia level alone justifies it. If however you do have a sudden spike in liver enzymes which may be representative of an acute hepatic event then go for it. Remember shock liver is an inclusion term under acute liver failure and is not the definition of the code. Many inclusion terms for codes are not in the exact same category as the overarching code above it. It is an imperfection of the coding system.

  • lprescott1lprescott1
    I agree this would be a great question to coding clinic- we need to point out when the code set does not reflect the reality of the clinical situation.
  • erica.remererica.remer
    I would have them monitor the Glasgow Coma Scale (with individual components) also. If it is not "with coma," but the patient is substantially impaired, it may risk adjust (MCC, etc.).
  • Sandra.Steed@nhrmc.orgSandra.Steed@nhrmc.org
    Has anyone heard it Coding Clinic was asked how to code it?  

  • BTC2018BTC2018
    It has been submitted to AHA Coding Clinic. Let's hope they respond and publish it.
  • Sanchezt2Sanchezt2
    Padawan5773 said:

    One of our physicians has documented acute hepatic encephalopathy... Hepatic encephalopathy codes to hepatic failure (it used to give us a CC in ICD 9, now gives us nothing), however with the word 'acute' it codes out to acute hepatic failure which is an MCC, which it really isn't clinically, because that would assume it is on the same level as shock liver.  So what do you really code?  Anyone else having the same issue?


  • Sanchezt2Sanchezt2
    I was wondering what  the status is regarding the submission to AHA coding clinic?  This is a hot topic at my facility right now
  • BTC2018BTC2018

    Here is the response from AHA Coding Clinic:

    Code K72.00, Acute and subacute hepatic failure without coma, is the correct code assignment when the provider documents acute hepatic encephalopathy.

    It would be appropriate to assign code K72.90, Hepatic failure, unspecified, when the provider documents hepatic encephalopathy without any further specification. In the documentation submitted for the example that was published in Coding Clinic, First Quarter 2017, page 41, the patient was admitted with chronic hepatitis C and chronic hepatic encephalopathy. Unfortunately, "chronic" was inadvertently omitted from the question.

    Code K70.40, Alcoholic hepatic failure without coma, is assigned when the documentation specifies the alcoholic nature of the hepatic encephalopathy/liver failure. It is appropriate to assign an additional code to capture cirrhosis when documented. Code K72.00 and code F10.129, Alcohol abuse with intoxication, unspecified, for a diagnosis of acute hepatic encephalopathy and alcohol intoxication without any further specification. Code F10.129 is the default code for alcohol intoxication as indicated by the Alphabetic Index: Intoxication -alcoholic--See, Alcohol, intoxication Alcohol, alcoholic, alcohol-induced -intoxication (acute)(without dependence) F10.129 It would be inappropriate to assign code G92, Toxic encephalopathy, or a code from category T51.-, Toxic effect of alcohol, when those conditions are not documented by the provider. Assign code T39.1X2A, Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter, and code K71.10, Toxic liver disease with hepatic necrosis, without coma, for documented acute hepatic encephalopathy due to acetaminophen overdose toxicity. See the following Index entry: Failure, failed -hepatic K72.90 --due to drugs (acute) (subacute) (chronic) K71.10

Sign In or Register to comment.