Coding corner: Seizures vs. epilepsy

Epilepsy is a brain disorder often associated with seizures. According to the Centers for Disease Control and Prevention, epilepsy affects more than 2 million adults in the U.S.

When a person has two or more seizures, he or she is considered to have a seizure disorder. A seizure is triggered by a change in normal brain activity and is the main sign of epilepsy. Seizures can also be caused by other medical problems. Symptoms can vary according to the cause and part of the brain that’s affected.

There can be multiple causes that trigger seizures and epilepsy, including:

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

If known, physician documentation must specify the reason for the seizure, such as epilepsy with known seizure disorder, traumatic brain injury, cerebrovascular accident, brain tumor, substance use disorder, electrolyte imbalance, genetic disorder or other.

If the cause is unknown or documentation is lacking, only the symptoms can be coded, which can result in failure to correctly capture the patient’s condition.

Supporting documentation related to treatment, such as anti-seizure medications, EEG or imaging studies, and specific blood tests, helps accurately capture and report the diagnosis.

To accurately assign a code, the specific description of the epilepsy or recurrent seizure condition is necessary. The code for epilepsy shouldn’t be assigned unless the physician specifically states epilepsy as the condition in the diagnostic statement.

The 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-CM codes. The ICD-10-CM coding system has more codes to accommodate higher specificity in capturing diagnoses. Some examples are given in the chart below.

Epilepsy and recurrent seizures require a fifth digit when coding in ICD-10-CM to indicate whether the patient’s condition is intractable. If a patient has intractable epilepsy, his or her condition may be difficult to control using anticonvulsant medications, such as phenytoin or phenobarbital.

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

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 all applicable state and federal laws and regulations.