Here is a coding clinic that may help answer your question: "Metabaolic encephalopathy - Guidelines" ICD-9-CM Coding Clinic, First Quarter 1988 Page: 3 to 4. It states "A variety of conditions may cause metabolic encephalopathy, such as brain tumors.....meningitis." " Metabolic encephalopathy (delirium) may be designated as principal diagnosis if it is the condition established after study to be chiefly responsible for the admission of the patient to the hospital for care. Otherwise, it is listed as an associated condition that exists at time of admission or that develops subsequently." I have found that encephalopathy is rarely a principal diagnosis. It is usually due to a disease process and reported as a secondary diagnosis. However, If sequenced as the principal diagnosis ensure appropriate diagnostic workup, treatment and monitoring is directed to the encephalopathy equal to other principal diagnosis options.
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