Neurology & Pain Management Coding Alert

Drill down on ICD-10 choice to shed more light on patient’s condition.

When you’re coding for patients with epilepsy, challenges abound. ICD-10 made coding for the condition far more specific, so you can paint a more complete picture of the patient’s epilepsy than you could with ICD-9.

Potential pitfall: With all that specificity, it can be easy to trip up on an epilepsy diagnosis — especially when you get past the G40.- three-character ICD-10 category.

Take a look at this advice on deciphering common epilepsy terms that are vital when you’re choosing the most accurate diagnosis code possible for each of your epilepsy patients.

Mark ‘1’ for Simple Partial Seizures

In order to choose the best epilepsy code, you’ll need to know the definition of a “simple” partial seizure. For diagnosis coding purposes, “simple partial seizures can be motor seizures that cause change in muscle activity. They can also be sensory seizures that cause changes in any one of the senses,” says Amy C. Pritchett, BSHA, CPC, CPMA, CPCI-I, CRC, CANPC, CASCC, CEDC, CCS, CMDP, CMPM, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS, 2015 president of the American Academy of Professional Coders chapter in Mobile, Ala.

ICD-10 coding: You would mark a 1 in the fourth character slot of your epilepsy diagnosis if the documentation indicates the patient exhibits evidence of simple partial seizures — for example, G40.1- (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures).

Seizure characteristics: According to Pritchett, simple partial seizures could change part of the patient’s nervous system that controls bodily functions, and they can also have psychological features, such as changing how people think, feel, or act.

“Patients may experience sensations of falling or movement or a labored speech or inability to speak at all,” Pritchett says. These symptoms might not be visible to the eye, however.

Often, “it is unclear if a person is having a simple partial seizure as they are normally fully alert and able to maintain contact and interact with others,” Pritchett relays. To get a bead on the seizure type, providers need to ask specific questions of the patients, and coders must pay attention to the notes to achieve a successful diagnosis.

Potential problem: If the coder misses evidence of simple partial seizures in the notes, or the provider fails to provide evidence of simple partial seizures, the diagnosis could be incorrect and lead to all sorts of potential headaches for the patient and practice.

Opt for ‘2’ on Complex Partial Seizures

Patients with epilepsy might also suffer from complex partial seizures, which are characterized by shorter seizures with a much longer fallout for the patient.

Complex partial seizures are more readily obvious to the eye because they can involve more symptoms that physically manifest themselves. Compared with simple seizures, complex partial seizures might include  automatisms (lip-smacking, picking at clothes, fumbling, etc.). Patients suffering from complex partial seizures might also be unaware of their surroundings or prone to wandering off.

Patients having complex partial seizures might be confused or lethargic for about 15 minutes during an episode. Once the seizure ends, these patients can suffer from functionality issues for hours afterward.

ICD-10 coding: If a patient has a complex partial seizure, then you’d mark a 2 in the fourth character slot of the epilepsy diagnosis — for example, G40.2- (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures).

If You See ‘Refractory’ in Notes, Look to Intractable Dx

When your provider cannot control a patient’s seizures with treatments, you’ll often see the physician refer to them as “refractory” or “uncontrolled.” For diagnosis coding purposes, these are terms associated with intractable epilepsy. Other terms that could indicate intractability include:

• pharmacoresistant
• pharmacologically resistant
• treatment resistant.

“When a patient is diagnosed with intractable epilepsy, this typically means that all medications, regimens, and treatments have failed and the patient is still suffering from seizures,” Pritchett says.

ICD-10 coding: If the patient has intractable epilepsy, you’d put a 1 in the fifth character spot of the ICD-10 code; for example, G40.21- (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable). When the epilepsy is not intractable, opt for a fifth character of 0; for example, G40.20- (… without intractability)

Careful: “Intractable does not relate to the type of seizure, and can occur with any type of seizures,” Pritchett says.

Choose Status Epilepticus When Seizures Stack Up

Once you’ve settled the simple vs. complex partial seizure and intractable and not intractable questions for your epileptic patient, you’ll need to decide whether or not the patient is suffering from status epilepticus. It’s important to know when a patient has status epilepticus, because these patients often deteriorate quickly due to the frequency and intensity of their seizures.

“This type of epilepsy is life-threatening and should be treated in the emergency room immediately,” Pritchett explains.

Status epilepticus occurs when seizures last longer than normal; generally, seizures that exceed 20 minutes are considered to have accompanying status epilepticus, Pritchett says. “The longer the seizure lasts, the more complex the seizure is,” she continues.

In fact, even shorter seizures might qualify for status epilepticus. According to the Epilepsy Foundation, “Over the last several decades, the length of seizure that is considered as status epilepticus has shortened. Years ago, a seizure needed to last longer than 20 minutes to be considered status epilepticus. In the last few years, it is now defined as any seizure greater than 5 minutes.”

Best bet: While the Epilepsy Foundation might consider these time parameters for status epilepticus, payers might not. Check with your payer if you’re unsure if a patient’s condition qualifies as status epilepticus.

Patients diagnosed with status epilepticus might also have repeated seizures for 30 minutes or longer. According to Pritchett, signs and symptoms of status epilepticus might include:

• focal paresthesia
• unilateral paresthesia
• numbness
• focal visual changes (flashing lights)
• obstruction in the visual field
• colorful hallucinations
• olfactory hallucinations
• atypical rising abdominal sensations.

ICD-10 coding: If a patient has status epilepticus, you’ll use 1 as the sixth character in your ICD-10 code; for example, G40.211 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, with status epilepticus). If status epilepticus isn’t present in the patient, use a 9 in the sixth character slot; for example, G40.219 (… without status epilepticus).