AHA Coding Clinic® for ICD-10-CM and ICD-10-PCS - 2022 Issue 1; Clarifications

Toxic Metabolic Encephalopathy due to Hepatic Encephalopathy

Coding Clinic, First Quarter 2021, page 13, states that it is appropriate to assign code G92, Toxic encephalopathy, for toxic metabolic encephalopathy (TME) due to acute on chronic hepatic encephalopathy. However, this advice does not seem correct since the provider did not document an associated toxic substance or an adverse effect of medication. Is it appropriate to assign code G92, when there is no external agent associated with the encephalopathy? It would appear that toxic metabolic encephalopathy or any other specified type of encephalopathy should only be reported when linked to another condition besides hepatic encephalopathy or hepatic failure. In this case, it appears that the encephalopathy should be inherent and not separately reported since it is linked to the liver encephalopathy. ...

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