Hepatic encephalopathy

This code represents a neuropsychiatric syndrome caused by liver dysfunction, leading to the accumulation of toxins (e.g., ammonia) in the bloodstream that affect brain function. It manifests as a spectrum of neurological and psychiatric abnormalities, ranging from subtle cognitive impairment to coma.

Apply this code when documentation explicitly states a diagnosis of hepatic encephalopathy, often in the context of chronic liver disease such as cirrhosis. Supporting documentation includes altered mental status, asterixis, and elevated ammonia levels in a patient with known liver failure.

• Differentiate from other causes of encephalopathy; ensure the documentation links the encephalopathy directly to liver disease.
• Always code the underlying liver disease (e.g., cirrhosis) as the primary diagnosis when applicable, with hepatic encephalopathy as a secondary diagnosis.
• Look for specific stages of hepatic encephalopathy (e.g., minimal, overt) in the documentation, although ICD-9-CM does not offer specific codes for these stages.