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
Update: Interesting article by Dr. Pinson in ACP. https://acphospitalist.org/archives/2018/02/coding-alcohol-use-disorders-part-2.htm
Is Dr Pinson saying that Providers should document acute toxic encephalopathy resulting from alcohol intoxication when intoxication is accompanied by delirium?
Is he also saying both G92 toxic encephalopathy and alcohol induced delirium would be coded? ( for a patient who has an acute reversible encephalopathic process rather than a nervous system degeneration or cerebral degeneration which represent a chronic encephalopathy)
The Insurance companies would look for all reasons not to pay a claim. I would rather argue based on the concise documentation and presentation of the patient at the time of admission. Also, the coding clinic first quarter 2017 page 39 and 40 is clear concerning coding and sequencing of these diagnoses.
Regards.
so we ruled out adverse effect. I would consider alcohol poisoning but that would have to be supported with a blood alcohol level beyond safe thresholds in a patient who probably required close observation for aspiration, may or may not have been intubated or had their stomach pumped etc.
You could consider metabolic encephalopathy if they had a multi-factorial presentation where by other unrelated factors such as acid base disruption and electrolyes may have been as much to blame as the alcohol, but that would need to be clearly stated. Intrestingly, if the drinking CAUSED the metabolic disruptions and you got a poor outcome in a patient, you COULD argue alcohol poisoning on that basis.
Even with non alcoholic substances i generally advised against the use of encephalopathy if the drug take was known to directly alter brain chemistry (so you are including benzos, anti psychotics, anti depressants, barbituates, basically any kind of sedative or sleeping pill as well as opoids), i always recommended drug induced delerium. I reserved toxic encephalopathy for systemic physiology disruption from secondary effects of medicines (over diureses, idiopathic responses, or accurring levels beyond the therapeutic threshold etc.). Since alcohol directly impacts brain chemistry, i would think you would be out of luck in trying to make a case for acute, non metabolic acute encephalopathy due to alcohol.
I don't believe following the advice in 1st quarter 2017 pg 39 is at all appropriate since again, the physician did not prescribe the alcohol, nor do i believe "toxic encephalopathy" is an appropriate diagnosis in a patient who took a substance known to directly effect brain chemisty as the patien'ts body is not "toxic" and they are having no secondary brain "malfunction" induced by metabolites...., they are simply demonstrating known effects of the substances they consumed as the medication impacts cognitive function and brain chemistry in very well know, documented, understood and established ways.