Hepatic Encephalopathy

Hepatic Encephalopathy

Code K76.82

hepatic encephalophy

We now have a code (K76.82) for Hepatic Encephalopathy for FY 2023.  This includes documentation such as: “Hepatocerebral intoxication” and “Portal-systemic encephalopathy.” 

It is important to note in the ICD-10-CM manual that we are to Code Also underlying liver diseases such as acute and subacute hepatic failure without coma (K72.00), alcoholic hepatic failure without coma (K70.40), chronic hepatic failure without coma (K72.10), hepatic failure with toxic liver disease without coma (K71.10), hepatic failure without coma (K72.90), icterus of newborn (P55-P59), postprocedural hepatic failure (K91.82), viral hepatitis without hepatic coma (B15.9, B16.1, B16.9, B17.10, B19.10, B19.20, B19.9). 

Patients with hepatic encephalopathy can lose consciousness and go into a hepatic coma.  Therefore, there is an Excludes1 Note that prohibits us from coding hepatic encephalopathy with codes that have ‘with coma’ in the description:  acute and subacute hepatic failure with coma (K72.01), alcoholic hepatic failure with coma (K70.41), chronic hepatic failure with coma (K72.11), hepatic failure with coma (K72.91). 

 

E/M Hot Topic: 2023 Changes Overview

Significant E/M changes are coming in 2023! Jeanie Heck, our director of Education, will begin her E/M Hot Topic series this month with an overview of these changes. Subsequent monthly E/M Hot Topic presentations will provide a deeper dive into the individual categories affected by these new changes.

For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to keep up-to-date.

Today’s Tip: Hypercholesterolemia and Hyperlipidemia

Hypercholesterolemia and HyperlipidemiaProviders often use the terms hyperlipidemia and hypercholesterolemia interchangeably. Technically, hyperlipidemia is a high or elevated lipid/fat level in the blood. High blood cholesterol is a lipid disorder. As a result, when hyperlipidemia and hypercholesterolemia are both documented in the record, only assign code E78.00 (Pure hypercholesterolemia) per Coding Clinic, Second Quarter 2022.  On the other hand, when ‘mixed hyperlipidemia’ and ‘hypercholesterolemia’ are both documented, assign code E78.2 (Mixed hyperlipidemia).  In this example, hypercholesterolemia is included in the E78.2 code.

Today’s Tip: Light Meconium-stained Fluid

Meconium fluidMeconium gives the amniotic fluid a greenish color. This is called meconium staining. Coding Clinic, Second Quarter 2022 clarifies ‘light meconium-stained fluid’ and how to code it.  The presence of any meconium staining may indicate fetal distress, therefore code O77.0 (Labor and delivery affected by meconium in amniotic fluid) is appropriate to code if documented as such.   There does not need to be documentation of fetal distress or maternal conditions to code.

2022 ICD-10-CM CODE O77.0

 

Today’s Tip: The Eliquis Coding Conundrum

Eliquis can be used as an anticoagulant or an antithrombotic. When a patient is on Eliquis long-term, it can be a coding conundrum. As published in Coding Clinic, Second Quarter 2022, ICD-10-CM classifies Eliquis as an anticoagulant medication.  Therefore, if long-term use of Eliquis is documented in the record, assign code Z79.01 (The long-term (current) use of anticoagulants).

Today’s Tip: Metabolic Bone Disease (MBD)

This condition is commonly documented along with chronic kidney disease (CKD). MBD is a broad term used to describe a group of bone disorders of bone strength usually caused by mineral abnormalities such as calcium, phosphorus, vitamin D, or magnesium. As published in Coding Clinic, Second Quarter 2022, when MBD is a component of another disease process, only the underlying condition (e.g., secondary hyperparathyroidism or renal osteodystrophy) is coded. If no underlying condition is documented, code the appropriate code from subcategory M89.8X-.

Today’s Tip: Lupus

Lupus Coding TipWhen Lupus (unspecified) is documented in a record, there is no default code. Therefore, it is important to have providers document this condition as precisely as possible.

For instance, document SLE (systemic lupus erythematosus) instead and add any complications that accompany this diagnosis.  It is often accompanied by Sjogren’s syndrome or Sicca syndrome, which have very specific codes.  Another solution is to develop facility or provider-specific guidelines to report M32.9 (SLE, unspecified) as a default for Lupus, unspecified.

Today’s Tip: Drug-induced Neuropathy

Drug-induced neuropathy (D62.0) is a diagnosis often missed by even the savviest and seasoned coders. It is sometimes seen in documentation as ‘CIPN’ (chemotherapy-induced peripheral neuropathy) and is a common side effect caused by antineoplastic agents.  Treatment includes steroids and nerve pain medication such as Gabapentin.

Drugs related to neuropathy

The most likely chemotherapy drugs related to neuropathy include platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.  This code can also be accompanied by another code for the adverse effect (T36-T50) to identify the drug. 

E/M Hot Topic: Telemedicine Update

Jeanie Heck, our Director of Education, begins our 2022 series of E/M Hot Topics with a discussion on Telemedicine. January’s Hot Topic provides an update from the CMS Final Rule​ as well as some reliable and reputable sources of information regarding telehealth.

For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to keep up-to-date.

E/M Hot Topic: Social Determinants of Health (SDOH2)

In our E/M Hot Topic discussions, we previously addressed the proper capture of Social Determinant of Health (SDOH) codes that can make a difference when determining the level of service for office visit codes. When used properly, they can impact the final MDM selection and subsequent reimbursement. In the November E/M Hot Topic, Jeanie Heck, our Director of Education, re-addresses this topic and reviews the new 2022 Chapter Specific Coding Guidelines for SDOH.

For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to find out when the next E/M Hot Topic is released.

E/M Hot Topic: Telehealth

In September’s E/M Hot Topic, Jeanie Heck, our Director of Education at Intellis, discusses telehealth. The 2022 Medicare Physician Fee Schedule Proposed Rule proposes that CMS allow some telehealth services to remain on the list until the end of 2023. This is intended to help determine if some of the services should be permanently added to the telehealth list following the COVID-19 PHE. During this presentation, Jeanie reviews some trustworthy and reliable sites to reference regarding telehealth.

For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to find out when the next E/M Hot Topic is released.

E/M Hot Topic: Drug Therapy Requiring Intensive Monitoring for Toxicity

August 2021

In this month’s E/M Hot Topic, Jeanie Heck, our Director of Education, discusses “Drug Therapy Requiring Intensive Monitoring for Toxicity”. This falls under the HIGH level in our Risk element or level 5 (99205/99215). We now have a published definition for this in our 2021 CPT manual.  This definition was further clarified by the CPT editorial panel in the Errata & Technical corrections document.


For additional information about E/M Guideline Updates education, contact us.

Follow us on LinkedIn to find out when the next E/M Hot Topic is released.