ICD-10 Coding for Hypoxic Encephalopathy(G93.1, P91.60, P91.61, P91.62)
Complete ICD-10-CM coding and documentation guide for Hypoxic Encephalopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypoxic Encephalopathy
G93.1Primary Range
Anoxic brain damage, not elsewhere classified
Primary code for hypoxic encephalopathy in adults and children over 28 days.
P91.6-Primary Range
Neonatal hypoxic ischemic encephalopathy
Primary code for hypoxic ischemic encephalopathy in neonates.
Metabolic encephalopathy
Used for metabolic encephalopathy, often in differential diagnosis with hypoxic encephalopathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G93.1 | Anoxic brain damage, not elsewhere classified | Use for adults and children over 28 days with hypoxic brain injury. |
|
| P91.60 | Neonatal hypoxic ischemic encephalopathy, unspecified | Use for neonates with unspecified severity of HIE. |
|
| P91.61 | Neonatal hypoxic ischemic encephalopathy, moderate | Use for neonates with moderate HIE. |
|
| P91.62 | Neonatal hypoxic ischemic encephalopathy, severe | Use for neonates with severe HIE. |
|
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 hypoxic encephalopathy
Essential facts and insights about Hypoxic Encephalopathy
Primary ICD-10-CM Codes for hypoxic encephalopathy
Decision Criteria
clinical Criteria
- MRI showing restricted diffusion in basal ganglia/cortex
documentation Criteria
- Documented hypoxic event with specific cause
Applicable To
- Hypoxic encephalopathy
- Anoxic encephalopathy
Excludes
- Metabolic encephalopathy (G93.41)
Clinical Validation Requirements
- Documented hypoxic event
- MRI showing restricted diffusion in basal ganglia/cortex
Code-Specific Risks
- Confusion with metabolic encephalopathy
Coding Notes
- Ensure documentation specifies 'hypoxic' or 'anoxic' and links to the cause.
P91.60 - Neonatal hypoxic ischemic encephalopathy, unspecified
Use for neonates with unspecified severity of HIE.
Applicable To
- Neonatal HIE
Clinical Validation Requirements
- Sarnat staging
- Umbilical cord pH <7.0
Coding Notes
Ensure Sarnat staging is documented.
P91.61 - Neonatal hypoxic ischemic encephalopathy, moderate
Use for neonates with moderate HIE.
Applicable To
- Moderate neonatal HIE
Clinical Validation Requirements
- Sarnat Stage II
- EEG showing moderate voltage suppression
Coding Notes
Ensure Sarnat Stage II is documented.
P91.62 - Neonatal hypoxic ischemic encephalopathy, severe
Use for neonates with severe HIE.
Applicable To
- Severe neonatal HIE
Clinical Validation Requirements
- Sarnat Stage III
- EEG showing burst suppression pattern
Coding Notes
Ensure Sarnat Stage III is documented.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Metabolic encephalopathy
G93.41Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypoxic Encephalopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G93.1.
Impact
Clinical: Misrepresentation of patient's condition., Regulatory: Potential for coding audits and denials., Financial: Loss of appropriate reimbursement.
Mitigation Strategy
Use specific terms like 'hypoxic' or 'anoxic'., Document underlying cause clearly.
Impact
Reimbursement: Incorrect DRG assignment, affecting reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Query for specificity to confirm hypoxic nature.
Impact
Risk of audits due to non-specific encephalopathy coding.
Mitigation Strategy
Ensure documentation specifies type and cause of encephalopathy.
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 Hypoxic Encephalopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypoxic Encephalopathy
Use these documentation templates to ensure complete and accurate documentation for Hypoxic Encephalopathy. These templates include all required elements for proper coding and billing.
Adult Hypoxic Encephalopathy
Specialty: NeurologyRequired Elements
- Diagnosis
- Etiology
- Imaging
- Neurological Deficits
- Treatment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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