Can you code Metabolic Encephalopathy to G9341 when its related to a CVA

I have reviewed multiple coding clinics and coding guidelines regarding capturing Encephalopathy with a CVA.  From what I have seen Encephalopathy is not considered inherent to a CVA.  My issues is when a Provider notes: Metabolic Encephalopathy due to CVA.  Is it appropriate to code G9341 as an MCC or is it appropriate to only code G9349?



  • Hello,

    You would code- G93.41 metabolic encephalopathy as the provider has specified an actual type of encephalopathy that is due to the CVA. The Coding Clinic from Second Quarter ICD-10 2018 Pages: 24-25 and the AHA coding handbook states to code the other encephalopathy code of G93.49 when the encephalopathy is linked to condition but a specified type of encephalopathy is not documented so like encephalopathy unspecified type due to CVA= G93.49 whereas metabolic encephalopathy due to cva=G93.41.

    I hope that helps and not sure if anyone else has anything to add.

  • Are there any metabolic derrangements or causes to lead you to believe the patient has metabolic encephalopathy?

  • When I think of metabolic encephalopathy, I think of something like hyponatremia or infection or acidosis as the cause rather than a CVA. I would look for any metabolic derangements in such cases that would indicate a metabolic encephalopathy is present: anecdotally, I have not seen this charted.

    Perhaps a SME on strokes can provide insight?

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