![]() The table also has an instructional note for T51 (toxic effect of alcohol) to use additional codes for “drunkenness” that are not included in the T51 codes. The ICD-10-CM table for G92 (toxic encephalopathy) has an instructional note to code first the toxic effects of alcohol or other poison. Coding Clinic, First Quarter 2017, stated that ciprofloxacin administered in proper doses can cause a toxic encephalopathy. Identify any toxic encephalopathy that might be present. Document any drug-drug interactions causing the altered mental state if alcohol or another recreational chemical is involved, this would be considered a poisoning. Note if any medications or drugs were administered as prescribed or if taken in overdoses, qualifying them as poisonings. Current effects of trauma or medications/chemicals. Designate whether the altered mental status is due to trauma or a medication/chemical and whether the diagnostic approach or treatment is in the active (“initial encounter”) or healing (“subsequent”) phase.Demyelinating diseases. These include multiple sclerosis, neuromyelitis optica, and others.Please discuss these with your coding managers, given that they need help knowing which conditions are integral to the term “encephalopathy” and which are not. It appears that Coding Clinic is allowing the coding of any specified encephalopathy however, this is very controversial. Previous advice stipulated that the encephalopathy due to a post-ictal state is inherent to the seizure, thus not allowing the encephalopathy to be coded. Coding Clinic, Second Quarter 2017, announced that if a physician documents that an encephalopathy is due to a lacunar stroke, the two are mutually exclusive and not inherent to each other, allowing G93.49 (other specified encephalopathy) to be coded along with the code for the stroke.Failure to document an underlying cause of an encephalopathy might subject a claim to denial, so always, if possible, specify what it is suspected to be. The NIH’s definition can be found at As such, we must describe the diffuse brain disease causing the altered mental state, such as metabolic issues (e.g., hyponatremia, uremia, hypoglycemia), toxins (e.g., those that are directly toxic to the brain or that have been administered in a poisonous amount), hypertensive emergency, acute or chronic liver failure, and the like. I prefer the National Institute of Health’s (NIH) definition that an encephalopathy is “a term for any diffuse (emphasis added) disease of the brain that alters brain function or structure” that manifests as a defined altered mental status (e.g., delirium, dementia, psychosis) and requires specificity as to its underlying cause. ![]() Some physicians equate any mental status change with the term “encephalopathy,” not considering the underlying brain disease (e.g., a neurodegenerative disorder, cerebral edema, or encephalitis). Encephalopathy. A challenging term that has many meanings, including, based on its etymology, any disease of the brain.Consider the word “encephalopathy” as well (see the next item) when documenting these underlying causes. Note: The term “multi-infarct dementia” requires additional documentation that it is the late effect of multiple strokes. Options include Alzheimer’s disease, Lewy-body dementia, late effects of multiple strokes, normal pressure hydrocephalus, some cases of Parkinson’s disease, and a host of others. Neurodegenerative disorders. To the extent that it’s possible to state what the underlying degenerative brain disease is, please do so.Remember that the various forms of altered mental states have underlying causes, which, if defined, diagnosed, and documented, accurately represent the patient’s condition for risk-adjustment purposes. Determine the underlying cause of the altered mental status
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