ICD-10 Coding for Autoimmune Encephalopathy(G04.81, G93.40)
Complete ICD-10-CM coding and documentation guide for Autoimmune Encephalopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Autoimmune Encephalopathy
G04.80-G04.89Primary Range
Other encephalitis and encephalomyelitis
This range includes specific codes for different types of encephalitis, including autoimmune encephalitis.
Encephalopathy
This range covers unspecified and specific types of encephalopathy, which may be relevant if autoimmune etiology is not confirmed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G04.81 | Other encephalitis and encephalomyelitis | Use when autoimmune etiology is confirmed by clinical, imaging, or laboratory findings. |
|
| G93.40 | Encephalopathy, unspecified | Use when encephalopathy is present but the specific cause is not identified. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for autoimmune encephalopathy
Essential facts and insights about Autoimmune Encephalopathy
Primary ICD-10-CM Codes for autoimmune encephalopathy
Decision Criteria
clinical Criteria
- Presence of subacute memory deficits and positive autoantibodies
documentation Criteria
- MRI and CSF findings supporting autoimmune process
Applicable To
- Autoimmune encephalitis
- Limbic encephalitis
Excludes
- Infectious encephalitis (A85.8)
Clinical Validation Requirements
- Subacute onset of memory deficits or altered mental status
- CSF pleocytosis
- MRI showing T2-FLAIR hyperintensities
- Positive neuronal autoantibodies
Code-Specific Risks
- Misclassification if autoimmune etiology is not confirmed
- Potential audit if documentation is insufficient
Coding Notes
- Ensure documentation supports autoimmune etiology with specific clinical findings.
G93.40 - Encephalopathy, unspecified
Use when encephalopathy is present but the specific cause is not identified.
Excludes
- Toxic encephalopathy (G92)
Clinical Validation Requirements
- Altered mental status without specific etiology
Coding Notes
Avoid using if specific etiology can be determined.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified convulsions
R56.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Autoimmune Encephalopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G04.81.
Impact
Clinical: Leads to misdiagnosis and inappropriate treatment., Regulatory: Increases risk of audit and compliance issues., Financial: May result in denied claims or lower reimbursement.
Mitigation Strategy
Ensure thorough documentation of clinical findings., Use specific codes when possible.
Impact
Reimbursement: May result in lower reimbursement., Compliance: Could lead to compliance issues during audits., Data Quality: Reduces specificity and accuracy of clinical data.
Mitigation Strategy
Use G04.81 if clinical and diagnostic criteria suggest autoimmune encephalitis.
Impact
Using unspecified codes when specific diagnosis is possible.
Mitigation Strategy
Ensure documentation supports specific autoimmune diagnosis.
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 Encephalopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Autoimmune Encephalopathy
Use these documentation templates to ensure complete and accurate documentation for Autoimmune Encephalopathy. These templates include all required elements for proper coding and billing.
Autoimmune Encephalitis Diagnosis
Specialty: NeurologyRequired Elements
- Patient history
- Neurological examination
- MRI findings
- CSF analysis
- Autoantibody testing
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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