Medicare Compliance & Reimbursement

Question: Our practice recently saw a patient who had been having intractable seizures. The patient was on medication, but his symptoms were not responding to it, so my physician suggested surgery. The surgery worked and the patient no longer requires the medication. We have been using a diagnosis for intractable seizure (345.11). Should we still be using that code? Answer: You may have been using 345.11 (Generalized convulsive epilepsy with intractable epilepsy) since the first stages of electroencephalogram (EEG) monitoring. Depending on your physician's documentation, you may now have to starting using 345.10 (Generalized convulsive epilepsy without intractable epilepsy) following the positive results of the surgery. With epilepsy codes, a fifth digit of "1" indicates that the condition is intractable, meaning it is not responsive to customary doses of medication, is poorly controlled or is treatment resistant. Since the patient had surgery, you should now use a "0" as the [...]