Knowledge Base Article

Q:

If a patient is diagnosed with encephalopathy secondary to gram negative pneumonia, which ICD-10-CM codes would be appropriate to report? J15.6 & G93.49 or J15.6 & G94?

A:

Per AHA Coding Advisor (question submitted by MMP) the “EAB (Editorial Advisory Board) recommends assigning codes G93.40, Encephalopathy, unspecified and a code for Gram-negative pneumonia” (J15.6).According to the AHA Coding Advisor, “the EAB of Coding Clinic recently resolved the issue of coding encephalopathy in diseases classified elsewhere”.

“Code G94, Other disorders of brain in diseases classified elsewhere, should only be assigned for those conditions with Index entries that directly point to code G94 for certain etiologies”.

Look for information, in regards to encephalopathy and/or code G94, to be published in the upcoming Coding Clinic 2nd Qtr. 2017.

Another thing you want to keep in mind; encephalopathy is generally a manifestation from a source such as pneumonia, sepsis, UTI etc. Quite often this could reflect a metabolic type encephalopathy that temporarily may affect a patient’s electrolytes, vitamin or other chemical type balance that would adversely alter or affect brain function.   In order to give greater specificity, be sure to query the provider if there is lack of supporting documentation.