Toxic Metabolic Encephalopathy vs. Delirium

[Faebinder]

What's the deal with neurologists liking to call delirium as "Toxic Metabolic Encephalopathy"? Why can't we agree on one name?

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[OldPsychDoc]

What's the deal with neurologists liking to call delirium as "Toxic Metabolic Encephalopathy"? Why can't we agree on one name?

Because they went into neurology to avoid things that sound "crazy"?

 

[billypilgrim37]

What's the deal with neurologists liking to call delirium as "Toxic Metabolic Encephalopathy"? Why can't we agree on one name?

Because insurance companies will pay for an EEG for an encephalopathy?

I kinda like the TME diagnosis. It's cute.

 

[Abram Hoffer]

http://www.merck.com/mmpe/sec16/ch213/ch213b.html

Delirium is an acute, transient, usually reversible, fluctuating disturbance in attention, cognition, and consciousness level. Causes include almost any disorder, intoxication, or drug. Diagnosis is clinical, with laboratory and usually imaging tests to identify the cause. Treatment is correction of the cause and supportive measures.

Delirium may occur at any age but is more common among the elderly. At least 10% of elderly patients who are admitted to the hospital have delirium; 15 to 50% experience delirium at some time during hospitalization. Delirium is also common among nursing home residents. When delirium occurs in younger people, it is usually due to drug use or a life-threatening systemic disorder.

Delirium is sometimes called acute confusional state or toxic or metabolic encephalopathy.

 

[Roy]

Here's the deal on this one... "Delirium" (293.0) is considered a nonspecific code by Medicare (and thus, most other payors). Clinically, it is the same as encephalopathy, whether metabolic (348.31) or toxic (349.82). Toxic encephalopathy is secondary to drugs (eg, prednisone, fentanyl, lithium OD, alcohol), while metabolic is pretty much everything else.

Metabolic encephalopathy and toxic encephalopathy are considered more specific diagnoses, meaning you have a better idea of what is causing the pt's delirium. I rarely use the term "delirium" in the chart unless I don't know what is causing it (or I might use the term "encephalopathy" without the qualifier).

Some payors will not pay for 293.0 because it is considered a "mental disorder", due to its being in the 290-319 ICD-9 range, which are considered Mental Disorders. Like, if they contract with a carve-out company to handle psychiatric claims, then the payor may require the bill goes thru the carve-out.

Finally, in states which use the newer APR-DRGs to pay for inpatient hospital claims, a secondary diagnosis of 348.31 or 349.92 will, in some cases, result in a higher severity level... and thus a higher payment. 293.0 almost never results in a higher severity level.

These are real nuts & bolts things, but important to learn how it all works.
-Roy from Shrink Rap
(see all Delirium-tagged Shrink Rap posts HERE)

 

[OldPsychDoc]

Great to have you on board, Roy. Say Hi to clinkshrink for me!

 

[Faebinder]

Here's the deal on this one... "Delirium" (293.0) is considered a nonspecific code by Medicare (and thus, most other payors). Clinically, it is the same as encephalopathy, whether metabolic (348.31) or toxic (349.82). Toxic encephalopathy is secondary to drugs (eg, prednisone, fentanyl, lithium OD, alcohol), while metabolic is pretty much everything else.

Metabolic encephalopathy and toxic encephalopathy are considered more specific diagnoses, meaning you have a better idea of what is causing the pt's delirium. I rarely use the term "delirium" in the chart unless I don't know what is causing it (or I might use the term "encephalopathy" without the qualifier).

Some payors will not pay for 293.0 because it is considered a "mental disorder", due to its being in the 290-319 ICD-9 range, which are considered Mental Disorders. Like, if they contract with a carve-out company to handle psychiatric claims, then the payor may require the bill goes thru the carve-out.

Finally, in states which use the newer APR-DRGs to pay for inpatient hospital claims, a secondary diagnosis of 348.31 or 349.92 will, in some cases, result in a higher severity level... and thus a higher payment. 293.0 almost never results in a higher severity level.

These are real nuts & bolts things, but important to learn how it all works.
-Roy from Shrink Rap
(see all Delirium-tagged Shrink Rap posts HERE)

You can bill with a neurologist code when doing a psychiatric consult? E.g. delirium post alcohol withdrawal superimposed on dementia... toxic encephalopathy or delirium secondary to alcohol withdrawal?

 

[Regnvejr]

You can bill with a neurologist code when doing a psychiatric consult? E.g. delirium post alcohol withdrawal superimposed on dementia... toxic encephalopathy or delirium secondary to alcohol withdrawal?

Sure. You can bill anything you find and evaluate. Now, the insurance company might not like it.

 

[Abram Hoffer]

You can bill with a neurologist code when doing a psychiatric consult? E.g. delirium post alcohol withdrawal superimposed on dementia... toxic encephalopathy or delirium secondary to alcohol withdrawal?

Trying not to derail OP... because neuro and psych boards are combined, does that make one competent in both fields? How is the differentiation made?

 

[Faebinder]

Sure. You can bill anything you find and evaluate. Now, the insurance company might not like it.

Mmm.. so you are more likely to get paid for the toxic/metabolic encephalopathy than the delirium... I'll have to look into using that. I was strictly told that we do not get paid when leaving nothing on the axis I diagnosis. Or I guess you can use both diagnoses.. put the delirium axis I and the toxic metabolic encephalopathy on axis III and bill with axis III?

 

[Regnvejr]

You can bill extra for increased difficulty of treatment per Axis III issues.