What does it mean?
 “Encephalo”-means Brain
 “Patho”-means Disease
 Encephalopathy is “caused by
something else”
 Implies a remote(outside of the CNS)
etiology
Symptoms
 Alteration in mental status
 Lethargy
 Personality changes
 Loss of memory
 Loss of ability to speak
 Hallucinations
 Loss of ability to swallow
 Seizures or tremors
 Delirium/Progressive loss of consciousness
Lab Tests That Help Diagnosis
 CBC
 Liver Function Tests
 Ammonia
 Blood Glucose
 Sodium Level
 BUN/Creatinine
 ABG’s
 Blood Cultures
 Toxicology Screens/Alcohol Levels
Other Tests That Help Diagnosis
 CT Scan/MRI
 EEG
 Ultrasound
 CXR
 Lumbar Puncture
 Blood pressure screening
ICD 9 Codes
 348.30
Encephalopathy, unspecified
 348.39 Other Encephalopathy
 348.31 Metabolic/Septic Encephalopathy
 349.82 Toxic Encephalopathy
 291.2
Alcoholic Encephalopathy
 437.2
Hypertensive Encephalopathy
 572.2
Hepatic Encephalopathy
How The Codes Can Affect DRG
 348.30
Encephalopathy, unspecified =MCC
 348.39 Other Encephalopathy =MCC
 348.31 Metabolic/Septic Encephalopathy =MCC
 349.82 Toxic Encephalopathy =MCC
 291.2
Alcoholic Encephalopathy =CC
 437.2
Hypertensive Encephalopathy =CC
 572.2
Hepatic Encephalopathy =MCC
Metabolic/Septic Encephalopathy
Will usually see with Pneumonia or UTI
Usually some underlying Dementia
May treat with anticonvulsants to reduce or halt seizures
May change diet, Sodium Bicarb and/or add nutritional
supplements
In severe cases, may need dialysis or organ replacement
Toxic Encephalopathy
Usually will see with poisonings of toxins/chemicals or
medicines like lead, pesticides, or cleaning products but
could also be from perfumes or air fresheners.
Treatment is mainly immediate removal from the
exposure to the toxin
May also put on anticonvulsants or change
diet/nutritional supplements
Alcoholic Encephalopathy
 Also known as Wernicke-Korsakoff Syndrome
 Found in malnourished chronic alcoholics as a result
of thiamine deficiency (Vit B1)
 Will usually see with alcohol withdrawal/delirium
tremors(DT’s)
 Treatment consists of reversing the thiamine
deficiency by giving supplements of thiamine and
possibly glucose
Hypertensive Encephalopathy
 Started recognizing as a diagnosis in 1928
 It is a neurological dysfunction that is induced by
malignant hypertension
 Most commonly seen in young to middle-aged patients
who suffer from hypertension
 Symptoms usually start 12-48 hours after a sudden
sustained increase in blood pressure which is usually
manifested by a severe headache
Hypertensive Encephalopathy
 Look for cerebral edema on CT/MRI
 Treatment is to lower BP with antihypertensive drugs
like Diazoxide, Hydralazine, Sodium Nitroprusside,
and Nitroglycerine
 May also be on Dilantin to control seizure activity
Hepatic Encephalopathy
 Caused by an accumulation of toxins normally
removed from the liver
 Pt. has a history of alcoholism, cirrhosis, or hepatitis
 Look for malnourished patients
 Treatment is the administration of Lactulose and/or
Lactitol
 Some antibiotics are given such as: Neomycin,
Metronidazole, and Rifaximin
Remember!
Encephalopathy is always due to an underlying cause.
The development of metabolic encephalopathy may be
the first manifestation of a systemic disease-most
importantly a diagnosis of Sepsis
Case Study #1
Opportunity: DRG - DI (Query for encephalopathy)
Case Summary: Admitted from NH with confusion, lethargy, decreased output. Alzheimer's dementia. Temp
99.5, 90% RA. Multiple electrolyte derangements. (H&P) Worsening renal function consistent with rhabdo,
dementia with acute delirium. DCS: …."significant improvement in mental status". CDS query for type of
dementia - response. Query supported with change in mental status and several contributing
factor: dehydration, UTI, ARF, electrolyte abnormalities all superimposed on severe Alzheimer's dementia.
Discuss: Additional query clarification for DCS comment that patient's admission diagnosis was "dementia of
acute delirium" - ? - not sure what that is...likely query
Case Study #2

Opportunity: DRG - Coding (Suggest re-sequence hypertensive encephalopathy as Pdx).
Case Summary: Pt. presents to ED 2/27 0700 with AMS, resp distress, hypertensive urgency (HTV
cardio and renal disease), ESRD, and CHF secondary to right heart failure. EMS record: 244/124,
223/116, 220/100 in the ER pt. received IV meds Hydralazine: 10 mg IVP, 20 mg IVP, Labetalol 10 mg
IVPX2, Cardene 2.5 mg IVP X2,. Consult note states ? malig HTN v CVA. Also Nephro consult states
HTN encephalopathy. Dr. Adams "admit to Critical for management and monitoring of HTN". Stroke
code called. CT/MRI in ED (-), no repeat. (PN 2/27) TIA/CVA; (Neuro consult 2/27 11:42am) -"mild
ptosis R eye...unable to communicate....inarticulate speech...gag blunted....probable CHF diastolic with
LV dysfunction"; (PN 2/28) CVA, ; (Neuro consult 2/27 11:42am) - "mild ptosis R eye...unable to
communicate....inarticulate speech...gag blunted....probable CHF diastolic with LV dysfunction,
possible component of HTV encephalopathy"; (PN Neuro 2/27 8 pm) "language improving....probable dx
hypertensive urgency; (PN 2/28 Neuro) All sign&symptoms gone; (PN 2/28 renal) "HWD/Hypertensive
urgency"; (3/3 Renal) ? hypertensive encephalopathy . 2 CDS queries: acuity of CHF (no response, no
impact for this case), TIA/CVA (responded); (PN 3/3) TIA(coded as TIA).
Discussion: Coding guidelines for possible/probable dx. Definition of terms - CVA: Physician education
re: CVA definitions and options: PN 2/28 states MRA/MRI CT negative but pt. documented as having
Neuro deficits >1 h after presentation to hospital. Definition of terms: malignant hypertension: Even
at these high levels, a hypertensive emergency (i.e., accelerated or malignant HTN) is only diagnosed if
this is an acute change and if an optic exam is noted. Both have accelerated HTN and malignant HTN
have end organ damage (as in this case) - the only difference is a bulging optic disk. NN doc: to as
documentation source to identify status of neuro deficits?
Query Example 1
Query Example 2
Questions… Discussions??
Cathy Lips, CCS
Coding Educator
Spartanburg Regional