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June 2019
Coding corner: Treating patients with seizure disorder
What is a seizure and how does it differ from epilepsy?
A seizure occurs from an episode of a sudden, uncontrolled electrical disturbance in the brain. It can cause abnormal movements and changes in awareness and behavior lasting anywhere from a few seconds to several minutes. Epilepsy is a condition characterized by recurrent seizures with no clear underlying cause. Status epilepticus describes a seizure that lasts longer than five minutes, or when seizures occur close together and the patient doesn't recover consciousness in between.
Depending on the type of seizure, signs and symptoms may include the following:
- A staring spell
- Uncontrollable jerking movements of the arms and legs
- Loss of consciousness or awareness
- Cognitive or emotional symptoms, such as fear, anxiety or déjà vu
- Temporary confusion following a seizure (postictal state)
Seizures can be caused by many underlying conditions:
- Congenital abnormalities
- Head injuries
- Poisoning
- Stroke
- Brain tumor
Documentation and coding tips
If known, provider documentation should specify the underlying cause of the seizure, such as:
- Low blood sugar
- Traumatic brain injury
- Alcohol or drug use, abuse, dependence or withdrawal
To assign a code properly, documentation of the seizure type is required. The following are a few common types of seizures:
- Tonic-clonic (grand mal)
- Myoclonic
- Atonic
- Tonic
- Clonic
- Absence (petit mal)
For greater specificity, providers should also document the status of the seizure:
- Intractable or not intractable
- Presence or absence of status epilepticus
Provider documentation must also include the treatment plan, if known, or plans to refer the patient to a neurologist or other specialist for treatment:
- Use of anti-convulsion medications such as carbamazepine, phenytoin, lamotrigine or levetiracetam
- Surgery
- Vagus nerve stimulation
- Responsive neurostimulation
- Deep brain stimulation
According to ICD-10-CM, a single seizure episode is classified to code R56.9, unspecified convulsions.
Epilepsy, or recurrent seizures, is classified to category G40. The ICD-10-CM coding system subcategorizes epilepsy even further:
- Generalized versus localized epilepsy
- Localized epilepsy with localized onset versus simple partial seizures
In addition, separate codes identify idiopathic versus symptomatic epilepsy with a fifth character to specify whether the seizures are intractable and a sixth character to identify the presence or absence of status epilepticus.
Some examples of seizure disorder codes appear in the chart below:
| Condition |
ICD-10 code |
| Unspecified convulsions (seizures) |
R56.9 |
| Post traumatic seizures |
R56.1 |
| Epilepsy, unspecified, not intractable, without status epilepticus (seizure disorder) |
G40.909 |
| Generalized idiopathic epilepsy and epileptic syndromes, not intractable with status epilepticus |
G40.301 |
| Localization-related (focal or partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, without status epilepticus |
G40.109 |
| Absence epileptic syndrome, intractable, with status epilepticus |
G40.A11 |
| Absence epileptic syndrome, not intractable, without status epilepticus |
G40.A09 |
| Epileptic seizures related to external causes, not intractable, without status epilepticus |
G40.509 |
Sources:
- www.mayoclinic.org**
- 2019 ICD-10-CM Professional for Physicians
**Blue Cross Blue Shield of Michigan doesn’t own or control this website.
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.
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