2025 ICD-10-CM code G05.3
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the nervous system - Inflammatory diseases of the central nervous system Diseases of the nervous system Feed
Encephalitis and encephalomyelitis occurring as a manifestation of another disease.
Modifiers are not typically used with G05.3, as it is a manifestation code.However, modifiers might be applicable to the procedures performed in the context of diagnosing or treating the underlying condition.
Medical necessity for coding G05.3 is established by the presence of clinically documented encephalitis or encephalomyelitis as a secondary condition to another diagnosed disease.The clinical documentation must support the link between the primary condition and the development of these inflammatory neurological manifestations.The treatment provided should address both the primary and secondary conditions.
The clinical responsibility involves diagnosing the underlying disease and the secondary encephalitis or encephalomyelitis. This includes taking a thorough patient history, conducting a physical examination, ordering appropriate diagnostic tests (such as blood tests, CSF analysis, brain imaging studies like MRI or CT scans), and determining the most appropriate treatment based on the primary diagnosis and the presence of the inflammatory condition.Treatment might involve antiviral medications, anti-inflammatory drugs, corticosteroids, antibiotics (if bacterial infection is present), and supportive care.Referral to specialists for long-term management, such as physical, occupational, or speech therapy, might be needed.
In simple words: This code describes brain or brain and spinal cord inflammation that happens because of another illness.The doctor will code the main illness first and then use this code to show the brain inflammation.
This code is used when encephalitis (brain inflammation) or encephalomyelitis (brain and spinal cord inflammation) is a secondary condition to another, primarily diagnosed disease.It indicates the presence of these inflammatory conditions but requires the underlying primary disease to be coded first. The code should never be the principal diagnosis.The underlying disease could be an infection, an autoimmune disorder, or other conditions that can cause inflammation in the central nervous system.This code is used to capture the secondary inflammatory manifestation.Detailed clinical documentation is crucial to support the coding choices, specifying the primary diagnosis and the presence of encephalitis or encephalomyelitis.
Example 1: A patient with systemic lupus erythematosus presents with new-onset headache, fever, and confusion.Brain imaging reveals encephalitis. The primary diagnosis is systemic lupus erythematosus (M32.19), and G05.3 is added to indicate the encephalomyelitis., A patient with HIV infection develops encephalitis.The principal diagnosis is HIV infection (B20), and G05.3 is used to document the encephalitis., A child with congenital toxoplasmosis presents with symptoms of encephalitis.The principal diagnosis is congenital toxoplasmosis (P37.1), and G05.3 is added.
Detailed clinical documentation is essential.This includes the complete history of present illness, thorough physical examination findings, results of diagnostic tests (blood tests, cerebrospinal fluid analysis, neuroimaging), and a clear statement of the underlying disease process and its relationship to the encephalitis or encephalomyelitis.Treatment notes should also detail the management of both the primary condition and the secondary brain inflammation.
** This code reflects the presence of encephalitis or encephalomyelitis as a complication or manifestation of a different medical condition.Accurate use requires careful consideration of the underlying disease to ensure appropriate coding.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Neurology, infectious disease, rheumatology, immunology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office