ICD-10 Coding for Autoimmune Encephalitis(G04.81)
Complete ICD-10-CM coding and documentation guide for Autoimmune Encephalitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Autoimmune Encephalitis
G04.80-G04.89Primary Range
Other Encephalitis and Encephalomyelitis
This range includes specific codes for various types of encephalitis, including autoimmune encephalitis.
Key Information: ICD-10 code for autoimmune encephalitis
Essential facts and insights about Autoimmune Encephalitis
Primary ICD-10-CM Code for autoimmune encephalitis
Decision Criteria
clinical Criteria
- Presence of specific autoantibodies in CSF or serum.
documentation Criteria
- Document subacute onset and exclusion of infectious causes.
Applicable To
- Autoimmune encephalitis
Excludes
- Infectious encephalitis (A81.9)
Clinical Validation Requirements
- Subacute onset of symptoms
- CSF autoantibodies
- MRI findings of limbic system hyperintensity
Code-Specific Risks
- Incorrect use can lead to insurance denials if documentation does not support autoimmune etiology.
Coding Notes
- Ensure documentation specifies autoimmune nature to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Autoimmune Encephalitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G04.81.
Impact
Clinical: Misdiagnosis risk., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Ensure thorough differential diagnosis is documented.
Impact
Reimbursement: Potential for reduced reimbursement due to unspecified coding., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in health data reporting.
Mitigation Strategy
Use G04.81 with appropriate documentation of autoimmune features.
Impact
Lack of specific documentation can lead to audit issues.
Mitigation Strategy
Ensure all clinical findings and test results are documented.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Autoimmune Encephalitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Autoimmune Encephalitis
Use these documentation templates to ensure complete and accurate documentation for Autoimmune Encephalitis. These templates include all required elements for proper coding and billing.
Neurology H&P for suspected autoimmune encephalitis
Specialty: NeurologyRequired Elements
- Chief complaint
- History of present illness
- Neurological examination
- Diagnostic test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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