Encephalopathy Denial

Hello all,

We have received a denial stating that toxic encephalopathy is integral to the F10-F19 series, and that specifically F1123 is a combination code and sufficiently captures encephalopathy and therefore further coding specificity is not allowed per the OCG I.B.9

The actual coding of the patient was poisoning as the PDx, G92 as MCC, and then F1123 was coded as well. We found a coding clinic (1Q 2017 pp.40) stating that G92 is not precluded from being coded along with poisoning. But we cannot find anything regarding the F10-F19 series.

Any help is appreciated!


  • I am assuming that the patient went into withdrawal after admission so the F11.23 code should be POA N. It wouldn't even be related to the toxic encephalopathy which is the reason for admission due to the poisoning.  This denial doesn't make much sense to me and I don't see any official guidance the precludes being able to assign all three codes together. 
  • I have successfully argued in the past when I could show that the altered mental status was longer than the typical withdrawal period.  If neurology has been consulted, I have argued that neurology isn't typically consulted for withdrawal, but rather an encephalopathy.  Also, if documentation indicates the patient is to follow-up as an outpatient with neurology, it would further support your argument.  I would also argue the point that Coding guidance does not exclude G92 in this case. 

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