ICD-10 Coding for Epilepsy(G40.109, G40.311)
Complete ICD-10-CM coding and documentation guide for Epilepsy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Epilepsy
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G40.109 | Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with simple partial seizures, not intractable | Use when the patient has focal seizures without intractability. |
|
| G40.311 | Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus | Use when the patient has generalized epilepsy with intractability and status epilepticus. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for epilepsy
Essential facts and insights about Epilepsy
Primary ICD-10-CM Codes for epilepsy
Decision Criteria
clinical Criteria
- Patient has simple partial seizures confirmed by EEG.
Applicable To
- Simple partial seizures
Excludes
- Complex partial seizures
Clinical Validation Requirements
- EEG showing focal epileptiform discharges
- Clinical history of simple partial seizures
Code-Specific Risks
- Misclassification if intractability is not assessed
Coding Notes
- Ensure seizure type is documented clearly.
G40.311 - Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus
Use when the patient has generalized epilepsy with intractability and status epilepticus.
Applicable To
- Intractable generalized epilepsy
Excludes
- Focal epilepsy
Clinical Validation Requirements
- EEG showing generalized epileptiform discharges
- History of status epilepticus
Coding Notes
Document intractability and status epilepticus clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified convulsions
R56.9Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Epilepsy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.109.
Impact
Clinical: Affects treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Review clinical notes for intractability documentation, Educate providers on coding requirements
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Leads to inaccurate clinical data.
Mitigation Strategy
Use G40 codes for confirmed epilepsy diagnoses.
Impact
Risk of audits due to incorrect epilepsy type coding.
Mitigation Strategy
Regular training on epilepsy coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Epilepsy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Epilepsy
Use these documentation templates to ensure complete and accurate documentation for Epilepsy. These templates include all required elements for proper coding and billing.
Generalized epilepsy with intractability
Specialty: NeurologyRequired Elements
- Seizure type
- Intractability status
- EEG findings
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Epilepsy? Ask your questions below.