Hepatic and metabolic encephalopathy

Hello! I searched this site for any mention of my specific question but don't see it so am putting it out there. I recently reviewed the chart of a patient admitted for hepatic encephalopathy (documented as such) in  which providers also documented metabolic encephalopathy secondary to high ammonia levels from liver cirrhosis. Would you code both the liver failure code for hepatic encephalopathy and the metabolic encephalopathy? I recently completed the Clinical Validation online bootcamp. As I understand it, the metabolic encephalopathy would not be coded unless it was due to another cause besides the liver disease (e.g. electrolyte disturbance, infection, etc.). Our coding manager disagrees due to the fact that there is no coding clinic that addresses this and no excludes 1 if you code both the liver failure code and metabolic encephalopathy.  Has anybody else had this issue?



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