Hepatic encephalopathy

This code represents a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction, ranging from subtle cognitive impairment to deep coma. It results from the accumulation of neurotoxins, primarily ammonia, that the diseased liver cannot adequately metabolize. The condition is often reversible with appropriate treatment.

Assign this code when documentation specifies hepatic encephalopathy without explicit mention of coma, or when the patient's altered mental status is attributed to liver failure but does not meet the criteria for a comatose state. This diagnosis is supported by clinical findings such as asterixis, confusion, disorientation, and elevated ammonia levels in a patient with known liver disease.

• Carefully review documentation to differentiate hepatic encephalopathy from hepatic failure with coma, as these conditions have distinct codes.
• Do not code this with any of the "Excludes1" codes, as they represent mutually exclusive conditions.
• Always sequence the underlying liver disease (e.g., cirrhosis, chronic hepatitis) as the primary diagnosis when applicable, with hepatic encephalopathy as a secondary diagnosis.