ICD-10 Coding for Generalized Tonic-Clonic Seizure(G40.409, G40.411)
Complete ICD-10-CM coding and documentation guide for Generalized Tonic-Clonic Seizure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Generalized Tonic-Clonic Seizure
G40.4Primary Range
Other generalized epilepsy and epileptic syndromes
This range includes codes for generalized epilepsy with tonic-clonic seizures, both intractable and not intractable.
Convulsions, not elsewhere classified
This range includes codes for single seizures and convulsions not classified as 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 |
|---|---|---|---|
| G40.409 | Other generalized epilepsy and epileptic syndromes, not intractable, without status epilepticus | Use when the patient has recurrent generalized tonic-clonic seizures without intractability or status epilepticus. |
|
| G40.411 | Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus | Use when seizures are intractable, meaning they persist despite adequate trials of antiepileptic drugs. |
|
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 generalized tonic-clonic seizure
Essential facts and insights about Generalized Tonic-Clonic Seizure
Primary ICD-10-CM Codes for generalized tonic-clonic seizure
Decision Criteria
clinical Criteria
- Recurrent generalized seizures confirmed by EEG
documentation Criteria
- Explicit mention of 'generalized tonic-clonic seizures'
Applicable To
- Generalized tonic-clonic seizures
- Grand mal seizures
Excludes
- Single seizures (R56.9)
Clinical Validation Requirements
- EEG showing generalized spike-wave activity
- Recurrent unprovoked seizures
Code-Specific Risks
- Misclassification as focal epilepsy
- Use of unspecified codes
Coding Notes
- Ensure documentation specifies 'generalized tonic-clonic' to avoid unspecified coding.
G40.411 - Other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
Use when seizures are intractable, meaning they persist despite adequate trials of antiepileptic drugs.
Applicable To
- Intractable generalized tonic-clonic seizures
Excludes
- Status epilepticus (G40.901)
Clinical Validation Requirements
- Seizures refractory to two or more antiepileptic drugs
- EEG confirmation of generalized epilepsy
Coding Notes
Document intractability clearly to justify this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Noncompliance with medication regimen
Z91.14Differential 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 Generalized Tonic-Clonic Seizure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.409.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Train staff on specific documentation requirements.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Use G40.409 or G40.411 if epilepsy is confirmed.
Impact
Risk of audits due to improper use of R56.9 for epilepsy.
Mitigation Strategy
Regular training and audits of coding practices.
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 Generalized Tonic-Clonic Seizure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Generalized Tonic-Clonic Seizure
Use these documentation templates to ensure complete and accurate documentation for Generalized Tonic-Clonic Seizure. These templates include all required elements for proper coding and billing.
Neurology Consult for GTCS
Specialty: NeurologyRequired Elements
- History of present illness
- Seizure description
- Medication history
- EEG and imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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