Encephalopathy - Can you code both Toxic and Metabolic

SkylerLee83SkylerLee83
in Clinical & Coding

Good Morning - there has recently been some discussion about coding of Encephalopathy.

Are you able to code both Toxic (G92) and Metabolic (G93.41) on the same patient and get both MCC's??

I have always understood that you do not code both.

Thanks in advance!

Comments

  • lmlund5@hotmail.comlmlund5@hotmail.com

    We only code one type of encephalopathy.  No double dipping is my understanding.

  • SkylerLee83SkylerLee83

    I have recently heard conflicting thoughts on this which is why I am hoping to clarify.

    1. No you cant code both. The subcategories in the code book take you to one code for Toxic Enceph if there is both Toxic and Metabolic. (If you look for Toxic Enceph there is a sub-category for metabolic and both have the G92 code.) If you search Metabolic Encephalopathy it has G93.41 with sub categories of drug induced and toxic both with G92 codes.
    2. Yes you can code both. From the book, G93.4(other and unspecified encephalopathy) category where metabolic falls under has changed toxic from excludes note 1 to an excludes note 2. (Excludes 1 - not coded here, Excludes 2 - not included here"). Meaning they may be reported separately as long as the medical documentation supports it.


  • MMascarenazMMascarenaz

    This may help,

    Prior to FY 2021, an Excludes1 note under code subcategory G93.4- (other and unspecified encephalopathy) prevented the assignment of a code from subcategory G93.4- when a patient also had a diagnosis of toxic encephalopathy (reported with ICD-10-CM code G92). 

    This Excludes1 note has been changed to an Excludes2 note for FY 2021. This means coders can now report both toxic encephalopathy and metabolic encephalopathy.

    On initial consideration this may seem like a benign change since encephalopathy is most often a secondary diagnosis and coding two MCCs has the same effect on the MS-DRG as only reporting one MCC. However, there are occasions when the ability to code both may lead to a higher MS-DRG.

  • MMascarenazMMascarenaz

    Additional information :)

  • SkylerLee83SkylerLee83

    Thank you MMascarenaz - where did you get that information from?

  • MMascarenazMMascarenaz
    edited December 2020

    My wonderful team of Coding Educators send these to our Coding Professionals and CDS Team, very helpful!

    justcoding.com | Medical Coding & Career Advancement

    Stay up to date: Review Excludes note changes for FY 2021 Nov 11, 2020

    by Sarah Nehring, RHIT, CCS, CCDS

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