Encephalopathy due to Alcohol

Does anyone have citations/definitions approved by Medical Staff for the term “METABOLIC or TOXIC encephalopathy due to ETOH”?  How does one distinguish a patient that may be simply be intoxicated with slurred speech and other impairments from what some CDI term “alcoholic encephalopathy”?  Reviewing the literature on our site, I find no author that has published articles or provided education on Encephalopathy that has commented on the existence of “alcoholic encephalopathy”. Is this a valid condition? 

Comments

  • Hi Paul,

    I have always thought of alcoholic encephalopathy as a chronic encephalopathy r/t alcoholism?

    Katy

  • Same here.  I should have clarified my question pertains to ‘acute, toxic (metabolic) encephalopathy.  I see many references to chronic forms of encephalopathy, and ETOH is stated as a cause of chronic encephalopathy in alcoholics.  But, does ETOH also result in acute, metabolic?  Thanks!
  • hmmm... good question. I think it would be hard to discern from intoxication and/or withdrawal unless you have metabolic abnormalities  pointing to a distinct metabolic issue (ex: electrolyte disturbances) beyond simply consumption of ETOH. I would not code 'alcoholic encephalopathy' if the patient is intoxicated.
  • Logical and thoughtful response, Katy!  Certainly agree that mere intoxication is not supportive of 'acute, metabolic or toxic' encephalopathy.  thank you. 
  • If the providers are documenting Acute Toxic Encephalopathy 2/2 to acute intoxication.  There are some who are interpreting the word "toxic" in this statement to Poisoning or Toxic Effect of Alcohol with Toxic Encephalopathy when patient's AMS and brain function appears to be more of just intoxication or drunkenness.  What clinical criteria moves a patient from just being acute intoxicated to toxic.  Blood alcohol level or GCS???? 
  • I have nothing to cite as a point of reference but alcohol-related metabolic encephalopathy could be considered, even in the setting of acute intoxication, when the electrolyte derangement is significant, i.e. magnesium - and the patient's mental status doesn't respond as expected with decreased BAL.  My thoughts.
  • I have nothing to cite as a point of reference but alcohol-related metabolic encephalopathy 
    Update:  Interesting article by Dr. Pinson in ACP.  https://acphospitalist.org/archives/2018/02/coding-alcohol-use-disorders-part-2.htm
  • I saw the question when I came to the forum to look for advise regarding this same issue.  The only information I find is from the 2019 CDI pocket guide that states, “toxic encephalopathy due to alcohol intoxication should be coded as T51.0x1a with G92, not as alcoholic encephalopathy (G31.2).”  Any thoughts on this? 
  • we have had a few denials for coding toxic metabolic encephalopathy in cases of patient coming in with AMS  and then going through withdrawal and the providers say toxic encephalopathy and severe etoh use disorder. They say that the code F10.231 alcohol dependence with withdrawal delirium should be used in  these cases.
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