Epilepsy and Seizures Disorders*

3.4 million people nationwide have epilepsy, making it one of the most common neurological disease globally, and people with epilepsy are up to three times more likely to die prematurely than those without it. Causes of epilepsy can include anything from head trauma or drug or alcohol intoxication of fever, stroke and metabolic disturbances.1

Epilepsy and recurrent seizures2

• G40.0-, Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset;

• G40.1-, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures;

• G40.2-, Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures;

• G40.3-, Generalized idiopathic epilepsy and epileptic syndromes;

• G40.A-, Absence epileptic syndrome;

• G40.B-, Juvenile myoclonic epilepsy (impulsive petit mal)

• G40.4-, Other generalized epilepsy and epileptic syndromes

• G40.5-, Epileptic seizures related to external causes

• G40.8-, Other epilepsy and recurrent seizures

• G40.9-Epilepsy, unspecified.

Test & Treatment

Blood tests, neurological exams, and lumbar punctures help to diagnose any infections, metabolic imbalances, or genetic conditions that could be the cause of a seizure and, in doing so, helps to indicate the likelihood of recurrence. EEGs also help by providing doctors with details regarding any possible patterns in the seizure activity. CT scans, MRIs, and PET scans can also reveal the existence of any lesions or abnormalities that could be attributed to a cause.

Depending on whatever cause is determined, possible treatments include surgical intervention, anti-seizure medications, neurostimulation, and dietary therapies to improve seizure control.

Documentation must confirm:

• Intractable or not –intractable

• With or without status epilepticus

Seizures / Convulsions2

• R56.0- Febrile convulsions

• R56.00- Simple febrile convulsions NOS

• R56.01- Complex febrile convulsions

• R56.1- Post traumatic seizures

• R56.9- Unspecified convulsions (includes seizures NOS).

Current vs. History of Documentation

• Avoid using the descriptor “history of” to describe a present diagnosis as it suggests the condition occurred in the past and is no longer current.

• To meet the M.E.A.T documentation values for patients with a chronic condition that is not actively showing symptoms, a provider may use descriptors such as inactive, quiescent, dormant, etc.

• It is possible for a patient on maintenance therapy to achieve long-term seizure-free status, while still having epilepsy. The two are not mutually exclusive, so ensure that conditions are documented clearly.

References and Additional Notes:

* This tool is not intended to diagnose, evaluate or treat patients. Each provider is responsible for the clinical and diagnostic decisions pertinent to their patient’s medical care.

** CMS-HCC scores are based on CMS’ 2020 community-nondual-aged enrollees.

1. Center of Disease Control, https://www.cdc.gov/epilepsy/data/index.html

2. Optum360, LLC. (2022). ICD-10-CM Expert for Hospitals

HCCs: Epilepsy and Seizure Disorders