Neurology & Pain Management Coding Alert

ICD-10 Coding:

Keep Up With Terms for Correct Epilepsy Dx Coding

Published on Tue May 16, 2023

Do you know what constitutes intractable epilepsy?

Patients with epilepsy might share quite a few common symptoms, but there are actually several layers of detail within the overall diagnosis of epilepsy.

Nuts & bolts: There are several different types of epilepsy, per ICD-10. Further, each type of epilepsy diagnosis could contain added elements that make choosing the correct diagnosis even more challenging.

Check out this primer on different types of epilepsy, so you’ll know what to do the next time you have to choose an ICD-10 code to represent this condition.

Know These Definitions Before Choosing Dx

Each type of epilepsy diagnosis will require the coder to know two definitions: intractable and status epilepticus. You’ll need to know whether either/both of these conditions accompany the epilepsy, as you’ll be expected to note it in the diagnosis code via the 5th (intractable/not intractable) and 6th characters (with/without status epilepticus).

Intractable: When a patient has intractable epilepsy, they have “a seizure disorder where seizures fail to become controlled with treatment. The seizures are sometimes referred to as ‘uncontrolled’ or ‘refractory,’” says Amy Pritchett, CCS, CPC-I, CPMA, CDEO, CASCC, CANPC, CRC, CDEC, CMPM, C-AHI, senior consultant at Pinnacle Enterprise Risk Consulting Services LLC in Centennial, Colorado. “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.”

Status epilepticus: For coding purposes, status epilepticus occurs when a seizure lasts longer than “average,” or when the seizures are so close together that the patient cannot recover between seizures. “A seizure noted to be over 20 minutes is considered to be status epilepticus. The longer the seizure lasts, the more complex the seizure is stated to be,” explains Pritchett.

Status epilepticus is a dangerous epilepsy complication, Pritchett notes. “Patients diagnosed with status epilepticus tend to have repeated seizures for 30 minutes or longer. This type of epilepsy is life-threatening, and should be treated in the emergency room immediately.”

Signs and symptoms of status epilepticus can include:

Focal or unilateral paresthesia or numbness
Focal or visual changes (flashing lights)
Obstruction in the visual field
Colorful hallucinations
Olfactory hallucinations
Atypical rising abdominal sensations

Here’s the Named Epileptic Dx Codes

For the purposes of this article, we’re going to address the named epilepsy ICD-10 codes first, followed by the more general diagnosis codes that could cover a number of epilepsy types.

Code: G40.0- (Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset)

According to Codify by AAPC, use this diagnosis for epilepsy with “seizures caused by abnormal electrical activity in only one group of cells or one part of the brain with no loss of consciousness.”

Code: G40.1- (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures)

“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. They can be autonomic seizures that cause changes in the part of the nervous system that automatically controls bodily functions and they can also be psychic seizures that change how people think, feel or experience,” according to Pritchett.

Code: G40.2- (Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures)

“Complex partial seizures start in the frontal lobe of the brain and tend to be shorter than ones from the temporal lobe. They oftentimes start in the frontal lobe and are also more likely to include spastic movements of the legs and pelvic regions,” says Pritchett. When a patient is having a complex partial seizure, they may be confused or lethargic for about 15 minutes and may not be fully functional for hours after.

Code: G40.3- (Generalized idiopathic epilepsy and epileptic syndromes)

This code refers to “a group of epileptic disorders caused by abnormal electrical activity on both sides of the brain without any structural brain abnormalities,” per Codify.

Code: G40.A- (Absence epileptic syndrome)

This code refers to epilepsy with seizures caused by abnormal electrical activity in the brain, “which manifest as very brief but often repetitive staring spells or altered consciousness with the patient alert and partially responsive,” according to Codify.

If you see these alternate terms listed to describe the patient’s epilepsy, you’d also choose G40.A-:

Childhood absence epilepsy [pyknolepsy]
Juvenile absence epilepsy
Absence epileptic syndrome, NOS

Code: G40.B- (Juvenile myoclonic epilepsy [impulsive petit mal])

This code represents epilepsy with a seizure disorder “beginning between the ages of 12 and 18 and lasting into adulthood and generally characterized by rapid, uncontrolled muscle jerks (myoclonic seizures) and muscle rigidity,” according to Codify.

Here’s the Unspecified Epileptic Dx Codes

While the above ICD-10 codes are pretty specific, the following codes are more nebulous. That’s because they describe several different epilepsy types that a patient might suffer from.

Check out this list of unspecified epilepsy diagnosis codes, along with some of the conditions that these codes might describe.

Code: G40.4- (Other generalized epilepsy and epileptic syndromes)

Use this code for:

Epilepsy with grand mal seizures on awakening
Epilepsy with myoclonic absences
Epilepsy with myoclonic-astatic seizures
Grand mal seizure NOS
Nonspecific atonic epileptic seizures
Nonspecific clonic epileptic seizures
Nonspecific myoclonic epileptic seizures
Nonspecific tonic epileptic seizures
Nonspecific tonic-clonic epileptic seizures
Symptomatic early myoclonic encephalopathy

Code: G40.5- (Epileptic seizures related to external causes)

Use this code for:

Epileptic seizures related to alcohol
Epileptic seizures related to drugs
Epileptic seizures related to hormonal changes
Epileptic seizures related to sleep deprivation
Epileptic seizures related to stress

Code: G40.8- (Other epilepsy and recurrent seizures)

Use this code for:

Epilepsies and epileptic syndromes undetermined as to whether they are focal or generalized
Landau-Kleffner syndrome

Code: G40.9- (Epilepsy, unspecified)

Use this code if you cannot get anything more specific from the chart than epilepsy. Among other epileptic conditions, the code might be used to represent: