Myxedema Encephalopathy
I have a case where the patient took herself off of her thyroid medication for an unknown length of time. She came in very confused, delusional. There is some question also as to whether she took an overdose amount of her Sinemet although there doesn't seem to be a way to know that for sure at this point. There has been discussion both verbally between the doctors and in the notes about Myxedema Crisis/Coma, versus Myxedema madness or even a psychosis, and now today noted as Myxedema Encephalopathy and I think that is where it will stay. I am having some difficulty with this case and establishing the correct DRG. I believe it to be Other specified Hypothyroidism as primary with Other Encephalopathy as a secondary. She is in ICU, treatment includes IV Levothyroxine, nephrology consulted as well. What are some thoughts about this one? thanks in advance
Comments
Myxedema with coma is coded as E03.5. I would interpret this code to include any encephalopathy since this code describe the myxedema due to thyroid disorder that is causing a coma.
Paul Evans, RHIA, CCDS
I concur: Some of the relative weight assignments do not seem 'equitable'? Example: Sepsis with MCC, in my opinion, should have higher R.W. considering it most often requires ICU care with subsequent high cost.
Paul