New Onset Seizure vs Encephalomalacia

bbogda@morrishospital.org

Not sure if chicken or egg should be PDx?  I am thinking egg.

Patient that came in and was admitted secondary to new onset seizures. He passed out at home, found snoring in bed and minimally responsive.

Neurology consult determined that this was due to seizure activity due to patient's “right frontal region encephalomalacia from his previous abscess versus empyema with chronic encephalomalacia changes locally”.  Neuro’s subsequent note states:

 “Patient with GM seizure due to right frontal lobe chronic encephalomalaciafrom brain abscess vs empyema 2 years ago. Pt had cranioplasty flap placed back 1 year ago. Was on Keppra from Rush university, however he d/c'd it, also not followed with his Rush MDs and neurosurgeons.  Presently stable, and MRI brain with pertinent findings with right frontal encephalomalacia, and post op changes.

Continue with Keppra 750 mg change to PO tomorrow BID. Keppra level in 1 week.

Would the seizure be more accurate to assign as PDx or the encephalomalacia since that was the cause of the seizure?

TIA,

Betty

evanspx@sutterhealth.org

Hi, Betty:  Since the encephalomalicia is a chronic condition and the reason for this admit is described as the seizures and the treatment revolved around the seizures, I believe the new seizures satisfy the definition of the Prinicipal Diagnosis.   Just my opinion....we have ‘many’ patients in our population noted as having encephalomalacia, too, but, and this is anecdotal, I don’t recall a situation in which that condition was ‘the’ chief reason causing an admission to acute care.   Other readers may be able to provide examples supporting encephalomalacia as the PDX?

Paul Evans, RHIA, CCDS

BTC2018

Encephalomalacia is an expected/known sequela of brain insult (hemorrhage, infection, surgery, etc.) so it would not, or at least rarely, be principal dx. I would code the seizure as principal and indicate as a sequela of the original insult, in this case, the abscess/empyema. 

bbogda@morrishospital.org

Thank you Paul and BTC2018.  Makes sense. 

Betty