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ICD-10 Guide
ICD-10 CodesChapter 6: Diseases of the nervous systemG05

G05

Billable

Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere

Chapter 6:Diseases of the nervous system

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

Code Description

ICD-10 G05 is a billable code used to indicate a diagnosis of encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere.

Key Diagnostic Point:

G05 encompasses encephalitis, myelitis, and encephalomyelitis that arise as complications of other diseases. These conditions involve inflammation of the brain (encephalitis), spinal cord (myelitis), or both (encephalomyelitis), often due to infectious agents such as viruses, bacteria, or parasites. The clinical presentation can vary widely, including symptoms such as fever, headache, seizures, altered mental status, and neurological deficits. Infections leading to these conditions may stem from systemic illnesses like viral infections (e.g., herpes simplex virus, West Nile virus), autoimmune disorders, or post-infectious processes. Accurate coding requires a thorough understanding of the underlying disease causing the encephalitis or myelitis, as well as the specific manifestations observed in the patient. This code is crucial for capturing the complexity of these conditions, which may require multidisciplinary management and can lead to significant morbidity.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires understanding of underlying diseases causing encephalitis or myelitis.
  • Differentiation between primary and secondary CNS infections.
  • Need for detailed clinical documentation to support coding.
  • Potential for overlapping symptoms with other neurological conditions.

Audit Risk Factors

  • Inadequate documentation of the underlying disease.
  • Failure to specify the type of encephalitis or myelitis.
  • Misclassification of the condition as primary rather than secondary.
  • Lack of supporting clinical evidence for the diagnosis.

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 focal neurological deficits.

Billing Considerations

Ensure clarity in distinguishing between infectious and autoimmune causes.

Infectious Disease

Documentation Requirements

Identification of infectious agents through cultures, serologies, and imaging studies.

Common Clinical Scenarios

Patients with systemic infections presenting with neurological symptoms.

Billing Considerations

Document the timeline of infection and neurological symptoms for accurate coding.

Coding Guidelines

Inclusion Criteria

Use G05 When
  • According to ICD
  • 10 guidelines, G05 should be used when encephalitis, myelitis, or encephalomyelitis is a complication of another disease
  • Coders must ensure that the underlying condition is documented and coded appropriately

Exclusion Criteria

Do NOT use G05 When
  • Exclusion criteria include cases where the encephalitis or myelitis is primary or idiopathic

Related CPT Codes

70450CPT Code

CT scan of the head

Clinical Scenario

Used to evaluate for signs of encephalitis or myelitis.

Documentation Requirements

Document indications for the CT scan and findings.

Specialty Considerations

Neurology specialists should ensure imaging correlates with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of encephalitis and myelitis, improving the accuracy of data collection and reimbursement processes. G05 provides a mechanism to capture the complexity of these conditions as secondary to other diseases.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of encephalitis and myelitis, improving the accuracy of data collection and reimbursement processes. G05 provides a mechanism to capture the complexity of these conditions as secondary to other diseases.

Reimbursement & Billing Impact

reimbursement processes. G05 provides a mechanism to capture the complexity of these conditions as secondary to other diseases.

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

When should G05 be used?

G05 should be used when encephalitis, myelitis, or encephalomyelitis is a complication of another disease, and the underlying condition is well-documented.