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Documentation and Coding for Epilepsy, Seizure Disorders & Convulsions January 18, 2023 Claims & Coding

A quick reference guide to assist with accurate, complete documentation and coding that reflects the true nature of a patient’s current health status at the highest level of specificity. Per ICD-10 official guidelines for reporting and coding “The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation, accurate coding cannot be achieved.”

Documentation & Coding Tips  

Documentation needs to be clear and detailed using the following terms to allow accurate ICD10 code selection  

Seizure Classes: 

  • Focal/partial (localization-related) seizures: start in one part of the brain and spread to others. The person may notice minor symptoms and feel that something is about to happen. As it spreads across the brain, more symptoms occur.  
  • Generalized seizures: surges of abnormal nerve discharges throughout the cortex of the brain, at the same time.  Includes terms such as absence (petit mal), myoclonic, tonic, atonic, clonic, and tonic-clonic (grand mal) 

Specificity: 

  • Intractability: 
    • Not Intractable 
    • Intractable: equivalent terms include pharmacologically resistant, treatment resistant, refractory (medically) and poorly controlled 
  • Status epilepticus: with or without 
  • Causative factors: alcohol, drugs, hormonal changes, sleep deprivation, stress, idiopathic, etc. 

Documentation: Medications, treatment & response

  • Epilepsy is incurable but can be controlled or limited by medications, diet, devices, or surgical techniques 
  • historical seizure/convulsion only, not ongoing 

   ICD-10

 Description Example of when to use codes in this category  

G40.1xx 

Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures 

 

G40.2xx 

Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures 

 

G40.3xx 

Generalized idiopathic epilepsy and epileptic syndromes, not intractable 

 

G40.A0x 

Absence epileptic syndrome 

  Includes Petit Mal  

G40.4xx 

Other generalized epilepsy and epileptic syndromes 

  Includes Grand Mal Seizure, unspecified 

G40.5xx 

Epileptic seizures related to external causes 

 

G40.8xx 

Other epilepsy 

 

G40.909 

Epilepsy unspecified, not intractable, without status epilepticus 

  Includes recurrent seizures & seizure disorder unspecified 

R56.1 

Post-traumatic seizures 

 

R56.9 

Seizure (convulsion), unspecified 

 

Resources: 

  • Optum 360 Encoder Pro.com 
  • Hopkins Medicine.org 
  • ICD-10-CM 2022 Coding Manual