Neurology & Pain Management Coding Alert

Rule out some specific types before you jump over to ‘other’ seizures.

Not able to categorize epilepsy? Currently, you’ll submit your claim with ‘Other forms of epilepsy’ or ‘unspecified epilepsy,’ depending upon your neurologist’s documentation. ICD-10 offers you an advantage of more specific codes for these conditions.

Confirm Intractable vs. Not Intractable

There are two ICD-9 codes that you can report for other forms of epilepsy, i.e. 345.80 (Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy) and 345.81 (Other forms of epilepsy and recurrent seizures, with intractable epilepsy). You report either of these codes depending upon whether or not the seizures are documented to be intractable.

Under ICD-10, you have specific codes for absence seizures, juvenile myoclonic epilepsy, and Lennox-Gastaut syndrome. For absence seizures, you select from codes G40.A01 (Absence epileptic syndrome, not intractable, with status epilepticus), G40.A09 (Absence epileptic syndrome, not intractable, without status epilepticus), G40.A11 (Absence epileptic syndrome, intractable, with status epilepticus) or G40.A19 (Absence epileptic syndrome, intractable, without status epilepticus). The factors that govern your choice of codes include the presence of status epilepticus and the response of seizures to treatment.

Similarly, for juvenile myoclonic epilepsy, you select from G40.B01 (Juvenile myoclonic epilepsy, not intractable, with status epilepticus), G40.B09 (Juvenile myoclonic epilepsy, not intractable, without status epilepticus), G40.B11 (Juvenile myoclonic epilepsy, intractable, with status epilepticus), or G40.B19 (Juvenile myoclonic epilepsy, intractable, without status epilepticus).

ICD-10 also has specific codes for Lennox-Gastaut syndrome. You may either report G40.811 (Lennox-Gastaut syndrome, not intractable, with status epilepticus), G40.812 (Lennox-Gastaut syndrome, not intractable, without status epilepticus), G40.813 (Lennox-Gastaut syndrome, intractable, with status epilepticus), or G40.814 (Lennox-Gastaut syndrome, intractable, without status epilepticus).

Check Documentation for Focus or Trigger

ICD-10 offers you specific codes for focal partial seizures and those that are precipitated by an external cause. When your neurologist documents a precise focus of origin of seizures, you report codes G40.101 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus), G40.109 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus), G40.111 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus), or G40.119 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus).

When your neurologist documents that seizures have an identified external trigger, you may report code G40.501 (Epileptic seizures related to external causes, not intractable, with status epilepticus), G40.509 (Epileptic seizures related to external causes, not intractable, without status epilepticus) depending upon whether or not status epilepticus is present.

Identify the potential external causes: Some factors that may precipitate epilepsy include excess alcohol, drugs (example, antidepressants and antipsychotics), hormonal changes (like in the menstrual cycle), sleep deprivation, stress, anxiety, and illness. "You may use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)," says Hammer.

Still Not Able To Categorize?

Your neurologist may not document a specific category or type of epilepsy despite extensive investigations. In this case, you may report G40.89 (Other seizures). In other situations, your neurologist may document a seizure which may not be of a specific type but may be intractable. You report code G40.804 (Other epilepsy, intractable, without status epilepticus) or G40.803 (Other epilepsy, intractable, with status epilepticus) depending upon the presence or absence of status epilepticus. Similarly, for epilepsy that is not intractable, you report G40.802 (Other epilepsy, not intractable, without status epilepticus) or G40.801 (Other epilepsy, not intractable, with status epilepticus).

Don’t Miss Spasms at Any Age

Your neurologist may document spasms in children or adults. These clearly are not infantile spasms. Once again, you will need to check if there is documentation in support of status epilepticus and how the spasms respond to treatment. You can then report G40.821 (Epileptic spasms, not intractable, with status epilepticus), G40.822 (Epileptic spasms, not intractable, without status epilepticus), G40.823 (Epileptic spasms, intractable, with status epilepticus), or G40.824 (Epileptic spasms, intractable, without status epilepticus).