Learn about meningoencephalitis, its diagnosis, and clinical documentation. Find information on meningoencephalitis symptoms, treatment, ICD-10 codes (G04.90, G04.91), CSF analysis, and differential diagnosis. This resource provides healthcare professionals with key insights into meningoencephalitis medical coding, clinical findings, and patient care related to viral, bacterial, and amebic meningoencephalitis.
Also known as
Meningitis, Encephalitis, Myelitis
Covers various infections and inflammations of the brain, spinal cord, and meninges.
Viral infections of CNS
Includes viral infections affecting the central nervous system, sometimes causing meningoencephalitis.
Viral infections characterized by skin lesions
Some viral infections with skin manifestations can also cause meningoencephalitis as a complication.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the meningoencephalitis infectious?
Yes
Specific infectious agent identified?
No
Due to non-infectious cause?
When to use each related code
| Description |
|---|
| Brain and meninges inflammation |
| Meningitis (inflammation of meninges) |
| Encephalitis (brain inflammation) |
Coding meningoencephalitis without identifying the causative agent (bacterial, viral, etc.) leads to inaccurate coding and impacts reimbursement.
Misdiagnosis between encephalitis and meningitis or failing to code both when present can result in underreporting severity and incorrect DRG assignment.
Insufficient documentation of related conditions like seizures or neurological deficits impacts accurate severity reflection and quality reporting.
Patient presents with symptoms suggestive of meningoencephalitis, including fever, headache, stiff neck (nuchal rigidity), altered mental status, and photophobia. Onset of symptoms was reported as [acute/subacute/gradual] beginning [timeframe]. Patient denies [relevant negatives, e.g., recent travel, known tick bites, immunosuppression] but reports [relevant positives, e.g., recent upper respiratory infection, sick contacts]. Physical examination reveals [positive findings, e.g., positive Kernig's sign, Brudzinski's sign, focal neurological deficits]. Differential diagnosis includes bacterial meningitis, viral meningitis, encephalitis, brain abscess, and subarachnoid hemorrhage. Lumbar puncture (LP) was performed, and cerebrospinal fluid (CSF) analysis revealed [CSF findings, e.g., elevated white blood cell count, elevated protein, decreased glucose]. Preliminary CSF Gram stain [results]. Blood cultures were drawn. Neuroimaging studies, including [CT scan/MRI], were ordered to evaluate for cerebral edema, focal lesions, or other intracranial pathology. Given the clinical presentation and preliminary findings, a presumptive diagnosis of meningoencephalitis has been made. Empiric antibiotic therapy with [antibiotic name and dosage] was initiated pending culture results. Patient is being closely monitored for neurological deterioration, seizures, and other complications. Further diagnostic testing, including viral PCR panels, may be performed based on CSF and culture results. Prognosis and treatment plan will be further discussed with the patient and family once all diagnostic results are available. ICD-10 code G00.4 (meningoencephalitis, unspecified) is provisionally assigned, subject to change pending definitive diagnosis. CPT codes for lumbar puncture (36000), CSF analysis (87070, 87206), blood cultures (87040), and neuroimaging (e.g., 70450 for CT, 70551 for MRI) are documented. This documentation supports medical necessity for inpatient admission for intravenous antibiotics, supportive care, and neurological monitoring.