Coding Conundrum: Encephalopathy

Dr. Jessica Sime presented to over 130 members of the North Georgia Health Information Management Association on the difficulties of coding for Encephalopathy. As a graduate of Northwestern Medical School, a practicing emergency physician in the Chicago area and a physician reviewer for FairCode, she is truly a subject matter expert. Her work with FairCode includes performing clinical validation reviews, writing appeals on behalf of hospitals and conducting educational workshops on clinical documentation improvement for Coders, CDI professionals and medical staff.

Some of the key takeaways from the session included:

• Encephalopathy is a spectrum
• Acute Encephalopathy is always due to an underlying condition
• Delirium/Agitation/Confusion are symptom codes
• Encephalopathy is the diagnosis code
• Encephalopathy is a clinical diagnosis
• Dementia should be distinguished from encephalopathy

Glasgow Coma Scores can be used for non-trauma conditions

Thank you @NGHIMA for the opportunity to present to your membership!

FairCode increases clean claim ratios by combining the domain expertise of experienced physicians with modern data science and analytics technologies to increase hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index (CMI) are more accurately captured with the correct DRG, and hospital reimbursements adjust accordingly. DRG Validation and physician conducted medical chart reviews happen in real time, significantly impacting hospital quality rankings, CMI and bottom-line results. From clinical validation and chart reviews to payor denial defense, FairCode’s physicians and data scientists are part of a hospital’s coding team. Add FairCode to your existing CDI initiatives and see the difference. Outcomes are measurable and significant. FairCode averages greater than 4:1 Gross Return on Investment.