![]() ![]() toxic encephalopathy, anoxic encephalopathy) can be coded. acute or chronic delirium, dementia, coma) and the underlying cause (e.g. Given that most of the specified altered mental statuses vary with differing types of encephalopathy, I believe that if these three elements of CDI review are answered that both the manifestation (e.g. The code is valid during the fiscal year 2023. Linkage of the cause and effect of these two condition R41.82 is a billable ICD-10 code used to specify a medical diagnosis of altered mental status, unspecified.The nature of the encephalopathy: Options include hypertensive, metabolic, anoxic, toxic, hepatic, etc.The nature of the altered mental status: Options include dementia, delirium, psychosis, stupor, coma, etc.Given that R41.82 is a Chapter 18 symptom code, given that the ICD-10-CM Official Guidelines for Coding and Reporting state that “ Signs and symptoms that are associated routinely associated with a disease process should not be assigned as additional codes, unless otherwise instructed by the classification,” and given that an altered mental status is integral to having an encephalopathy, I would only report G93.40.Īfter CDI Effort: CDI specialists need to obtain the specificity of the following: ![]() R41.82 altered mental status, unspecified.Demonstrated benefit in Strep Pneumo (adults) and H.Q: Can we code altered mental status as a manifestation and encephalopathy together?Ī: In answering the question, we must consider what is documented before or after the CDI effort.īefore CDI Effort: If all that is documented is “altered mental status” and “encephalopathy,” I would assign the following two codes:.Steroids attenuate if given before/concurrently.Bacterial lysis increases CNS inflammation.aphasia) 97% negative predictive value for abnormal CT N Engl J Med 2001, Hasbun et al. Any sick pt with AG metabolic acidosis and resp alkalosis.Septic appearing elderly (most common misdiagnosis).NCSE- If Benzo’s fail… Comatose (esp post grand mal) Altered but preserved consciousness Impaired Consciousness Could be Absence Full standard status Tx Rapid progression to GA (midaz, propofol) Phenytoin Phenobarb VPA (std Status tx) VPA Phenobarb Avoid: Phenytoin Carbamazapine Treatment diverges then if it is Absence.Mostly from animal studies and case series.NCSE still probably damages neurons, but not nearly as much as convulsive.Urgent EEG/Neurology to confirm/categorize if at all unclear of dx.Previous neurosurgery Small study Poor design Not much else out there.J NeurolNeurosurg Psychiatry 2003 74:189–191 Most predictive Clues New confusion or abnormal behavior in the elderly.Minor tremors, twitching or eye deviations.Altered MS with no other obvious cause.Stroke, tumor, neurosurg, CNS catastrophe/trauma.Any recent or remote seizure risk factors.Add to DDx of “Altered/Comatose/Bizarre behavior of no obvious cause”.Controversial and developing clinical and EEG criteria.Persistent neurological seizure activity without obvious visible seizure activity.Step 3: Emergent Interventions The Coma Cocktail:Do DON’T, or don’t DON’T? Step 2: Absent an emergent A or B… Look for neurological findings before you sedate/paralyze Subscribe to Codify by AAPC and get the code details in a flash. Diffuse cerebral disease (infection, edema) ICD-10 code R41.82 for Altered mental status, unspecified is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.2008 May 56(5): 823–830īeware: “Grandpa’s just a little confused today”Ģ Causes of altered LOC Behavior (Cerebral activity) Arousal (R.A.S.) Chronic, slowly progressive, non-emergent ĬAM for Delerium Acute onset and/or Fluctuating Course AND Inattention WITH EITHER Disorganized thinking OR Altered Level of Consciousness 91-97% sensitivity 85-94% specificity J Am Geriatr Soc.Discuss thinking about altered MS in presentation categories ĭisorders of Consciousness Hypervigilent Confused Obtunded Drowsy/Lethargic Stupor Coma.Sean Wilde MargrietGreidanus MaApproach to Altered Mental Status ![]()
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