Coding corner: Seizures vs. epilepsy

According to the Centers for Disease Control and Prevention, epilepsy affects more than 2 million adults in the U.S. A brain disorder, epilepsy is sometimes called a seizure disorder.

When a person has two or more seizures, they’re considered to have a seizure disorder. A seizure is a change in normal brain activity and is the main sign of epilepsy, but also can occur due to other medical problems. Symptoms vary according to the part of the brain that’s affected.

There can be multiple causes leading to a seizure. Conditions associated with seizures and epilepsy include:

• Developmental problems, such as cerebral palsy
• Head injuries
• Poisoning

If known, physician documentation must specify the reason for the seizure or convulsion, such as seizure disorder, traumatic brain injury, genetic disorders or epilepsy. If the cause is unknown or documentation is lacking, only the symptoms can be coded and could result in failure to correctly capture the patient’s condition. To accurately assign a code, the specific description of the epilepsy or recurrent seizure condition is necessary.

Supporting documentation related to treatment, such as anti-seizure medications, EEG tests and specific blood tests, also helps in accurately capturing and reporting the diagnosis.

Convulsions and seizures occur in certain types of epilepsy, but they can also be symptoms of other diseases, such as cerebrovascular accident, brain tumor, alcoholism and electrolyte imbalance. The code for epilepsy should not be assigned unless the physician specifically states epilepsy as the condition in the diagnostic statement.

The different types of seizures are grand mal, myoclonic, atonic, tonic, clonic and absence (petit mal). Accurate documentation of the seizure type is important in assigning the correct ICD-10 codes. The ICD-10 coding system has more codes to accommodate higher specificity in capturing diagnoses. Some examples are given in the table below.

Epilepsy and recurrent seizures require a fifth digit when coding in ICD-10 to indicate whether the patient’s condition is intractable or not. If a patient has intractable epilepsy, his or her condition is difficult to control using anticonvulsant medications, such as phenytoin or phenobarbital.

As with many other conditions, physician documentation is critical to accurately coding a diagnosis of seizure or epilepsy.

To access a flier on seizures and epilepsy, click here.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.