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v1.0.0
ICD-10 Guide
ICD-10 CodesG93.4

G93.4

Billable

Other and unspecified encephalopathy

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G93.4 is a billable code used to indicate a diagnosis of other and unspecified encephalopathy.

Key Diagnostic Point:

Encephalopathy refers to a broad category of brain disorders that alter brain function or structure. The term 'other and unspecified encephalopathy' encompasses various conditions that do not fit neatly into more specific categories. This may include metabolic encephalopathies, toxic encephalopathies, and those resulting from infections or hypoxia. Symptoms can vary widely, including cognitive dysfunction, seizures, altered consciousness, and motor disturbances. The underlying causes can be multifactorial, including systemic diseases, exposure to toxins, or complications from other neurological disorders. Accurate diagnosis often requires a thorough clinical evaluation, including imaging studies and laboratory tests, to identify the underlying etiology. Treatment is typically directed at the underlying cause, and supportive care is essential for managing symptoms. Given the complexity of encephalopathy, it is crucial for healthcare providers to document the specific clinical context and any associated conditions to ensure appropriate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of underlying causes leading to encephalopathy.
  • Overlap with other neurological disorders requiring careful differentiation.
  • Potential for multiple co-existing conditions complicating diagnosis.
  • Need for comprehensive documentation to support the diagnosis.

Audit Risk Factors

  • Inadequate documentation of the underlying cause.
  • Failure to specify associated symptoms or conditions.
  • Misuse of the code for more specific encephalopathies.
  • Lack of clarity in clinical notes regarding the patient's condition.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, imaging results, and laboratory tests.

Common Clinical Scenarios

Patients presenting with altered mental status, seizures, or cognitive decline.

Billing Considerations

Ensure that all potential causes are explored and documented to support the diagnosis.

Internal Medicine

Documentation Requirements

Comprehensive history and physical examination, including review of systems and relevant lab results.

Common Clinical Scenarios

Patients with systemic illnesses presenting with neurological symptoms.

Billing Considerations

Document any metabolic or toxic factors contributing to encephalopathy.

Coding Guidelines

Inclusion Criteria

Use G93.4 When
  • According to ICD
  • 10 coding guidelines, G93
  • 4 should be used when the encephalopathy is not specified as due to a known cause
  • Coders must ensure that the documentation supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use G93.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99223CPT Code

Initial hospital care, typically 70 minutes or more.

Clinical Scenario

Used when a patient with encephalopathy is admitted for evaluation and management.

Documentation Requirements

Comprehensive history, examination, and medical decision-making.

Specialty Considerations

Neurologists should document neurological assessments thoroughly.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of encephalopathy, improving the ability to capture the complexity of these cases. G93.4 serves as a catch-all for cases that do not fit into more specific categories, emphasizing the need for thorough documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of encephalopathy, improving the ability to capture the complexity of these cases. G93.4 serves as a catch-all for cases that do not fit into more specific categories, emphasizing the need for thorough documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of encephalopathy, improving the ability to capture the complexity of these cases. G93.4 serves as a catch-all for cases that do not fit into more specific categories, emphasizing the need for thorough documentation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of encephalopathy?

Common causes include metabolic imbalances, toxic exposures, infections, and systemic diseases such as liver failure or kidney disease.

How can I differentiate between types of encephalopathy?

Differentiation often relies on clinical presentation, history, and diagnostic tests. Specific codes exist for conditions like hypoxic-ischemic encephalopathy (G93.1) and post-viral fatigue syndrome (G93.3).