Toxic encephalopathy integral to dependence with intox/withdrawal delirium?

lthompson5@ecommunity.com

Patient admitted with toxic encephalopathy 2/2 benzodiazepine dependence uncomplicated documented. 1. Would we code the more specific benzo dependence with delirium (but would need to query for intoxication or withdrawal since not documented)  2. Would we code also the Toxic encephalopathy in addition to the benzo dependence with delirium or would it be considered integral to that condition when/if the more specific code with delirium is added?   I don't see any instructional notes in the index/tabular that excludes using both but wondered if the coding guideline on conditions that are an integral part of a disease process may apply here.   Thanks for any input! 

michaelahabib88

I usually do query for toxic/metabolic encephalopathy with any substance or alcohol intoxication.
Surprisingly CMS considers encephalopathy a more severe diagnosis than delirium (which I disagree with), so you need to show the most specific and highest severity diagnosis.

That's my personal opinion and practice and we never got any denials due to this practice.

On the other hand, I have an IPA experience and I have never denied encephalopathy with substance or alcohol intoxication.

lthompson5@ecommunity.com

Auditor is making the point that in ICD 10 there are combo codes that describe various effects of drug use and these combo codes eliminate the need to use additional codes to describe the patient' mental status such as encephalopathy. Coding guidelines state that multiple coding should not be used when the classification provides a combo code that clearly identifies all of the elements documented in the diagnosis.