The ICD-10-CM Coding Handbook notes that toxic encephalopathy is caused by exposure to toxic substances or as an adverse effect of medication, but not due to infection. Metabolic encephalopathy is the suggested diagnostic language when encephalopathy is related to an infection (e.g., UTI, sepsis, influenza). The term “toxic metabolic” encephalopathy codes ONLY to toxic encephalopathy, and should not be used to describe a metabolic encephalopathy due to infection.
External chart auditors frequently challenge the validity of encephalopathy diagnoses. This could be due to the lack of a universally accepted definition of encephalopathy. For coding purposes, Salem Health uses the ICD-10-CM approved definitions. The definition for encephalopathy Salem Health uses is “a global brain dysfunction manifested by an altered mental state that is not due to an underlying neurodegenerative state.”
Encephalopathy always has an underlying cause. Finding the cause of encephalopathy by way of blood work, CSF studies, imaging, patient history, and EEGs may allow the attending physician to differentiate between various etiologies of encephalopathy. Per the ICD-10-CM Coding Handbook, the type and acuity of any encephalopathy is required documentation.
In the case of toxic encephalopathy, this means the attending physician must document the specific agent (i.e., drug) considered to be the cause. It is also important to document whether the drug toxicity qualifies as an adverse effect or poisoning. This distinction may affect the sequencing of diagnoses and ultimately affect the coding classification.
Thank you so much for all you do to ensure accurate coding of our charts at Salem Health!