Metabolic encephalopathy

Patient has non-alcoholic steatohepatitis (NASH), presented with confusion.  Ammonia level was elevated.  Lactulose was ordered.  The physician documented metabolic encephalopathy due hyperammonemia.

From the above documentation can this be coded to acute hepatic encephalopathy or is a query needed to clarify?


  • The metabolic encephalopathy is not linked to the "liver disease".  It is linked to hyperammonemia (an elevation of ammonia that can occur as a result of liver failure).  While there is not an Exclude 1 note to prevent the coding of G93.41 (metabolic encephalopathy) as an MCC to K75.81 (NASH) as DRG 441, NASH is considered an inflammatory liver disease.  I would not code Acute hepatic encephalopathy without a link, documentation, or query for specificity.  However, I respond with the hope that I can obtain feedback in the event of my incorrect assessment!  Thank you
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