ICD-10 Coding for Tonic-Clonic Epilepsy(G40.2, G40.4)
Complete ICD-10-CM coding and documentation guide for Tonic-Clonic Epilepsy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tonic-Clonic Epilepsy
G40.0-G40.9Primary Range
Epilepsy and recurrent seizures
This range includes all epilepsy types, including tonic-clonic seizures, with specific codes for 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 |
|---|---|---|---|
| G40.2 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus | Use when seizures are controlled and no status epilepticus is present. |
|
| G40.4 | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus | Use when seizures are intractable but no status epilepticus is present. |
|
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 tonic-clonic epilepsy
Essential facts and insights about Tonic-Clonic Epilepsy
Primary ICD-10-CM Codes for tonic clonic epilepsy
Decision Criteria
clinical Criteria
- Seizures are controlled with medication, no status epilepticus.
Applicable To
- Non-intractable tonic-clonic seizures without status epilepticus
Excludes
- Epileptic seizures related to alcohol (G40.5)
Clinical Validation Requirements
- EEG showing generalized spike-and-wave activity
- Documented seizure frequency and type
Code-Specific Risks
- Misclassification if status epilepticus is present
Coding Notes
- Ensure documentation specifies seizure type and control status.
G40.4 - Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
Use when seizures are intractable but no status epilepticus is present.
Applicable To
- Intractable tonic-clonic seizures without status epilepticus
Excludes
- Epileptic seizures related to alcohol (G40.5)
Clinical Validation Requirements
- Documentation of 3+ failed AEDs
- Seizure frequency despite treatment
Coding Notes
Document all failed AEDs with dosages and durations.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tonic-Clonic Epilepsy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.2.
Impact
Clinical: Impairs treatment planning and monitoring., Regulatory: Increases risk of coding audits., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Use specific terminology, Include seizure frequency and type
Impact
Reimbursement: May lead to incorrect DRG assignment., Compliance: Increases audit risk due to lack of specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use G40.2 or G40.4 based on intractability and status epilepticus.
Impact
High audit risk due to lack of specificity in coding.
Mitigation Strategy
Ensure documentation supports specific epilepsy type and control status.
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 Tonic-Clonic Epilepsy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tonic-Clonic Epilepsy
Use these documentation templates to ensure complete and accurate documentation for Tonic-Clonic Epilepsy. These templates include all required elements for proper coding and billing.
Neurology Progress Note
Specialty: NeurologyRequired Elements
- Seizure type and duration
- Postictal state
- Medication adherence
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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