ICD-10 Coding for Gabapentin(G40.A01, G56.41, G25.81)
Complete ICD-10-CM coding and documentation guide for Gabapentin. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gabapentin
G40-G47Primary Range
Epilepsy and recurrent seizures
Gabapentin is primarily used for seizure disorders, specifically epilepsy.
Nerve, nerve root, and plexus disorders
Gabapentin is used for neuropathic pain, which falls under nerve disorders.
Other extrapyramidal and movement disorders
Gabapentin is used for restless legs syndrome, classified under movement disorders.
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.A01 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus | Use when documenting epilepsy with simple partial seizures confirmed by EEG. |
|
| G56.41 | Causalgia of right upper limb | Use for neuropathic pain in the right upper limb with documented symptoms. |
|
| G25.81 | Restless legs syndrome | Use for documented restless legs syndrome with appropriate lab findings. |
|
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 gabapentin
Essential facts and insights about Gabapentin
Primary ICD-10-CM Codes for gabapentin
Decision Criteria
clinical Criteria
- EEG confirmation of focal seizures
Applicable To
- Simple partial seizures
Excludes
- Intractable epilepsy
Clinical Validation Requirements
- EEG showing focal epileptiform discharges
- ≥2 unprovoked seizures
Code-Specific Risks
- Ensure EEG confirmation is documented.
Coding Notes
- Ensure seizure type and EEG findings are documented.
G56.41 - Causalgia of right upper limb
Use for neuropathic pain in the right upper limb with documented symptoms.
Applicable To
- Neuropathic pain
Excludes
- Non-neuropathic pain
Clinical Validation Requirements
- Documented symptoms like burning, tingling, or electric shock-like pain
Coding Notes
Document specific nerve involvement and symptoms.
G25.81 - Restless legs syndrome
Use for documented restless legs syndrome with appropriate lab findings.
Applicable To
- RLS
Excludes
- Periodic limb movement disorder
Clinical Validation Requirements
- Worsening symptoms at rest
- Iron studies showing ferritin <75 μg/L
Coding Notes
Document symptom pattern and lab results.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Generalized idiopathic epilepsy and epileptic syndromes, not intractable, without status epilepticus
G40.309Neuralgia and neuritis, unspecified
M79.2Periodic limb movement disorder
G47.61Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gabapentin to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.A01.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials.
Mitigation Strategy
Ensure EEG results are included in documentation., Review coding guidelines for epilepsy.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Impacts accuracy of patient records.
Mitigation Strategy
Use specific neuropathic pain codes like G56.41 with documented symptoms.
Impact
Inadequate documentation of long-term use can trigger audits.
Mitigation Strategy
Ensure detailed documentation of treatment rationale and patient response.
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 Gabapentin, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gabapentin
Use these documentation templates to ensure complete and accurate documentation for Gabapentin. These templates include all required elements for proper coding and billing.
Neuropathic pain management
Specialty: Pain ManagementRequired Elements
- Detailed pain description
- Nerve conduction study results
- Gabapentin dosage and response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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