ICD-10 Coding for Recurrent Seizure(G40.109, R56.9)
Complete ICD-10-CM coding and documentation guide for Recurrent Seizure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Recurrent Seizure
G40-G47Primary Range
Epilepsy and recurrent seizures
This range includes codes for epilepsy and recurrent seizures, which are essential for coding confirmed diagnoses of epilepsy.
Convulsions, not elsewhere classified
This range is used for coding single or unspecified seizures, not confirmed 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 |
|---|---|---|---|
| G40.109 | Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus | Use when there is a confirmed diagnosis of focal epilepsy with complex partial seizures, not intractable. |
|
| R56.9 | Unspecified convulsions | Use for single seizure episodes or when epilepsy is not confirmed. |
|
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 recurrent seizures
Essential facts and insights about Recurrent Seizure
Primary ICD-10-CM Codes for recurrent seizure
Decision Criteria
clinical Criteria
- Confirmed recurrent seizures with EEG evidence
documentation Criteria
- Detailed seizure type and intractability status
Applicable To
- Focal seizures
- Complex partial seizures
Excludes
- R56.9 (Unspecified convulsions)
Clinical Validation Requirements
- EEG showing focal epileptiform activity
- Clinical history of recurrent seizures
Code-Specific Risks
- Misclassification if intractability is not properly documented
Coding Notes
- Ensure documentation specifies seizure type and intractability.
R56.9 - Unspecified convulsions
Use for single seizure episodes or when epilepsy is not confirmed.
Applicable To
- Single seizure episode
Excludes
- G40.XXX (Epileptic seizures)
Clinical Validation Requirements
- Clinical presentation of a single seizure
- No prior history of epilepsy
Coding Notes
Avoid using for recurrent seizures without further investigation.
Differential 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 Recurrent Seizure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.109.
Impact
Clinical: Impacts treatment decisions, Regulatory: Non-compliance with documentation standards, Financial: Potential for claim denials
Mitigation Strategy
Use specific terminology for seizure types, Document medication trials and responses
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate medical records and statistics.
Mitigation Strategy
Use R56.9 for single or unspecified seizures without confirmed epilepsy.
Impact
Risk of coding errors due to insufficient documentation of seizure type and intractability.
Mitigation Strategy
Implement detailed documentation protocols for seizure characteristics.
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 Recurrent Seizure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Recurrent Seizure
Use these documentation templates to ensure complete and accurate documentation for Recurrent Seizure. These templates include all required elements for proper coding and billing.
Recurrent focal seizures with intractability
Specialty: NeurologyRequired Elements
- Seizure type and frequency
- Intractability status
- EEG and MRI findings
- Medication history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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