Hepatic ENcephalopathy

nursesds1

Question please. Per our coding director, there is not a code for hepatic encephalopathy. We are being told we can't query or clarify hepatic encephalopathy acuity. We have to query hepatic encephalopathy and instead list viable options of hepatic failure acute w coma, hepatic failure acute w/o coma, etc. 

Do you all still query or do you clinically validate a diagnosis of hepatic encephalopathy? 
Thank you

BTC2018

Here is the response from AHA Coding Clinic:

Code K72.00, Acute and subacute hepatic failure without coma, is the correct code assignment when the provider documents acute hepatic encephalopathy.

It would be appropriate to assign code K72.90, Hepatic failure, unspecified, when the provider documents hepatic encephalopathy without any further specification. In the documentation submitted for the example that was published in Coding Clinic, First Quarter 2017, page 41, the patient was admitted with chronic hepatitis C and chronic hepatic encephalopathy. Unfortunately, "chronic" was inadvertently omitted from the question.

Code K70.40, Alcoholic hepatic failure without coma, is assigned when the documentation specifies the alcoholic nature of the hepatic encephalopathy/liver failure. It is appropriate to assign an additional code to capture cirrhosis when documented. Code K72.00 and code F10.129, Alcohol abuse with intoxication, unspecified, for a diagnosis of acute hepatic encephalopathy and alcohol intoxication without any further specification. Code F10.129 is the default code for alcohol intoxication as indicated by the Alphabetic Index: Intoxication -alcoholic--See, Alcohol, intoxication Alcohol, alcoholic, alcohol-induced -intoxication (acute)(without dependence) F10.129 It would be inappropriate to assign code G92, Toxic encephalopathy, or a code from category T51.-, Toxic effect of alcohol, when those conditions are not documented by the provider. Assign code T39.1X2A, Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter, and code K71.10, Toxic liver disease with hepatic necrosis, without coma, for documented acute hepatic encephalopathy due to acetaminophen overdose toxicity. See the following Index entry: Failure, failed -hepatic K72.90 --due to drugs (acute) (subacute) (chronic) K71.10