ICD-10 Coding for Lennox-Gastaut Syndrome(G40.811, G40.812, G40.813, G40.814)
Complete ICD-10-CM coding and documentation guide for Lennox-Gastaut Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Lennox-Gastaut Syndrome
G40.811-G40.814Primary Range
Epileptic syndromes with Lennox-Gastaut syndrome
This range specifically covers Lennox-Gastaut syndrome, differentiating by intractability and status epilepticus.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G40.811 | Lennox-Gastaut syndrome, not intractable, with status epilepticus | Use when LGS is not intractable but includes status epilepticus. |
|
| G40.812 | Lennox-Gastaut syndrome, not intractable, without status epilepticus | Use when LGS is not intractable and does not include status epilepticus. |
|
| G40.813 | Lennox-Gastaut syndrome, intractable, with status epilepticus | Use when LGS is intractable and includes status epilepticus. |
|
| G40.814 | Lennox-Gastaut syndrome, intractable, without status epilepticus | Use when LGS is intractable and does not include 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 Lennox-Gastaut Syndrome
Essential facts and insights about Lennox-Gastaut Syndrome
Primary ICD-10-CM Codes for lennox gastaut syndrome
Decision Criteria
clinical Criteria
- Presence of status epilepticus with documented EEG findings
Applicable To
- Lennox-Gastaut syndrome with status epilepticus
Excludes
- Other epileptic syndromes
Clinical Validation Requirements
- EEG confirms slow spike-wave (1.5-2.5 Hz) and generalized paroxysmal fast activity
- Status epilepticus duration ≥5 mins documented
Code-Specific Risks
- Misclassification as intractable without proper documentation
Coding Notes
- Ensure EEG and status epilepticus documentation are present.
G40.812 - Lennox-Gastaut syndrome, not intractable, without status epilepticus
Use when LGS is not intractable and does not include status epilepticus.
Applicable To
- Lennox-Gastaut syndrome without status epilepticus
Excludes
- Other epileptic syndromes
Clinical Validation Requirements
- ≥2 seizure types documented (e.g., tonic and atonic)
- No failure of ≥2 ASMs at therapeutic doses
Coding Notes
Ensure documentation of seizure types and absence of ASM failures.
G40.813 - Lennox-Gastaut syndrome, intractable, with status epilepticus
Use when LGS is intractable and includes status epilepticus.
Applicable To
- Intractable Lennox-Gastaut syndrome with status epilepticus
Excludes
- Other epileptic syndromes
Clinical Validation Requirements
- Documented failure of ≥2 ASMs
- Status epilepticus requiring ICU intervention
Coding Notes
Ensure documentation of ASM failures and ICU intervention for status epilepticus.
G40.814 - Lennox-Gastaut syndrome, intractable, without status epilepticus
Use when LGS is intractable and does not include status epilepticus.
Applicable To
- Intractable Lennox-Gastaut syndrome without status epilepticus
Excludes
- Other epileptic syndromes
Clinical Validation Requirements
- ≥3 ASM failures with dosage/duration specifics
- Video EEG showing ≥3 seizure types
Coding Notes
Ensure documentation of ASM failures and seizure types.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Post-traumatic seizures
R56.1Moderate intellectual disabilities
F71Encounter for psychiatric assessment
Z00.6Severe intellectual disabilities
F72Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Lennox-Gastaut Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.811.
Impact
Clinical: Inadequate clinical picture of patient's condition., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Provide detailed seizure type and frequency, Document medication trials and responses
Impact
Reimbursement: Incorrect coding may lead to lower DRG reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure documentation supports the specific LGS diagnosis with EEG and seizure type details.
Impact
Reimbursement: Potential denial of claims for intractable epilepsy., Compliance: Non-compliance with coding standards., Data Quality: Misrepresentation of patient's clinical status.
Mitigation Strategy
Verify and document failure of at least two ASMs at therapeutic doses.
Impact
High risk of audits for incorrect intractability coding without proper documentation.
Mitigation Strategy
Ensure documentation of ASM failures and seizure frequency.
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 Lennox-Gastaut Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Lennox-Gastaut Syndrome
Use these documentation templates to ensure complete and accurate documentation for Lennox-Gastaut Syndrome. These templates include all required elements for proper coding and billing.
Neurology Progress Note
Specialty: NeurologyRequired Elements
- Seizure types and frequency
- EEG results
- Medication history
- Developmental status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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