G93.41: Metabolic encephalopathy

Yes. Code G93.41 is a valid five character billable code. Its parent G93.4, other and unspecified encephalopathy, is a subcategory header and cannot be reported on a claim. Category G93 cannot be reported either. Code G93.41 takes no seventh character.

The three sit at different points on one axis. Code R41.82, altered mental status, unspecified, is a symptom code. It carries an Excludes1 note reading altered mental status due to known condition, code to condition. It is displaced as soon as the record names a cause. Code F05, delirium due to known physiological condition, sits in Chapter 5 and carries a Code first instruction for the underlying physiological condition. Its inclusion terms include acute or subacute confusional state, delirium of mixed etiology, delirium superimposed on dementia and sundowning. Code G93.41 sits in Chapter 6 and carries no Code first instruction. No Excludes note stands between category F05 and subcategory G93.4. Both may be reported where the record documents both.

No. Code G93.41 does not appear in the CMS-HCC v28 ICD-10-CM mapping for payment year 2026. Codes G93.40 and G93.49 do not appear either. Hepatic encephalopathy (K76.82) does map, to HCC 63, Chronic Liver Failure/End-Stage Liver Disorders. Severity designation under the MS-DRG system and mapping under the risk adjustment model are separate questions and have to be checked separately.

The chart needs five things. The first is a provider statement of encephalopathy rather than a statement of confusion or altered mental status. The second is the metabolic derangement the provider attributes it to. The third is the patient's baseline mental status and a documented departure from it. The fourth is the same diagnosis and the same type carried consistently through the record. The fifth is treatment and monitoring directed at the condition. The Livanta Claims Review Advisor of October 2022 lists an examination showing altered mental status that is not the patient's baseline, consistent documentation that encephalopathy is present, consistent documentation of its type, and clinical support for that type as the elements reviewers check. The same publication names a record that says the patient was alert and oriented, and a diagnosis introduced only by a post discharge query, as reasons higher weighted DRG claims are changed.

Code G92.8. Toxic metabolic encephalopathy is an inclusion term at G92.8, other toxic encephalopathy. The single documented phrase resolves to one code and G93.41 is not added for it. Where the record instead documents a toxic encephalopathy from one cause and a metabolic encephalopathy from a separate cause, both codes are reported. Subcategory G93.4 carries an Excludes2 note for toxic (metabolic) encephalopathy (G92.8), which permits that pairing. AHA Coding Clinic, Second Quarter 2024, pages 14 and 15, addresses metabolic encephalopathy reported with toxic metabolic encephalopathy. Note that the code is G92.8 rather than G92. Category G92 itself is no longer billable.

The tabular does not fix the order. Subcategory G93.4 carries no Code first instruction, and no etiology and manifestation convention applies. Section II of the FY2027 ICD-10-CM Official Guidelines, effective 1 October 2026, defines the principal diagnosis as the condition established after study to be chiefly responsible for occasioning the admission. Where the encephalopathy is what brought the patient in and drove the workup, G93.41 can be sequenced first even where the note says it is due to a urinary tract infection. AHA Coding Clinic, Second Quarter 2018, page 22, addresses that sequencing and puts it on the condition found after study to be responsible for the admission. Two situations override this. Where severe sepsis is documented, the underlying infection is sequenced first, then a code from subcategory R65.2, then G93.41 as the acute organ dysfunction. Where the encephalopathy is integral to another documented condition, such as a postictal state, it is not reported separately at all.

The code is the same and the payment rules are not. MS-DRG assignment applies to inpatient claims only. On an outpatient or professional claim G93.41 supports medical necessity and the complexity of medical decision making rather than a DRG. Under Section IV.H of the FY2027 ICD-10-CM Official Guidelines, a diagnosis documented as probable, suspected, questionable or rule out is not coded as confirmed in the outpatient setting. On the inpatient side an uncertain diagnosis documented at discharge may be coded as confirmed under the UHDDS rules. Resolution during the stay does not remove the code. A secondary diagnosis is reportable when it required clinical evaluation, therapeutic treatment, diagnostic procedures, an extended length of stay or increased nursing care. Record the date the mental status returned to baseline rather than leaving a reviewer to infer it.

G93.41 is unchanged in the FY2027 update, effective 1 October 2026. The FY2027 tabular addenda add the inclusion term midline shift of brain at G93.5 and change nothing in subcategory G93.4. The FY2026 change sat in the MS-DRG grouper. CMS deleted MS-DRGs 077, 078 and 079, moved hypertensive encephalopathy (I67.4) into MS-DRGs 070, 071 and 072, and retitled that triplet from Nonspecific Cerebrovascular Disorders to Other Cerebrovascular Disorders. Those are the MS-DRGs a G93.41 principal diagnosis groups to under the FY2027 MS-DRG v44 grouper.