Neurology & Pain Management Coding Alert

Ensure documentation for treatment response to support descriptors. ICD-10 can make your epilepsy coding even more complicated if you're foggy on the disease specifics. You potentially will be miscoding if you miss any part in the descriptors. Prepare now for correctly reporting status epilepticus, febrile convulsions, and post traumatic seizures when ICD-10 goes into effect. Confirm Response to Treatment for Status Epilepticus Under ICD-9, you have specific codes to report status epilepticus: 345.2 ( Petit mal status epileptic) and 345.3 (Grand mal status epileptic). Another code is 345.7x (Epilepsy partialis continua). "This is a form of partial status epilepticus with simple motor manifestations that are maintained for over 1 hour, with clonic activity restricted to 1 body part and recurring at fairly regular intervals," says Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, owner of MJH Consulting in Denver, CO. Your choice of codes depends on the intensity of muscle contractions. Patients with petit mal epilepsy have minor myoclonic spasms that may not be evident, whereas grand mal epilepsy is recognized by violent generalized muscle contractions.   In ICD-10, for corresponding codes to 345.2 and 345.3, your correct choice will hinge on how the status responds to therapy.   For seizures that respond well to therapy and are not intractable, you'll report G40.301 (Generalized idiopathic epilepsy and epileptic syndromes, not intractable, with status epilepticus). For seizures that are not responsive to treatment (intractable), you'll submit G40.311 (Generalized idiopathic epilepsy and epileptic syndromes, intractable, with status epilepticus) or G40.319 (Generalized idiopathic epilepsy and epileptic syndromes, intractable, without status epilepticus) depending upon whether status epilepticus is present.   The ICD-9 code 345.70 (Epilepsia partialis continua without intractable epilepsy) maps to G40.101 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, not intractable, with status epilepticus) if status epilepticus is present. Similarly, 345.71 (Epilepsia partialis continua with intractable epilepsy) maps to G40.111 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, with status epilepticus) if status epilepticus is present. "However, the ICD-10 alphabetic index directs coders to G40.511 (Special epileptic syndromes, intractable, with status epilepticus) for Epilepsia partialis continua with status epilepticus again with the 5th digit indicating whether the condition is intractable or not," says Hammer.   If you look at the descriptors of G40.301, G40.311, and G40.319, you'll see that the codes refer to 'generalized idiopathic epilepsy and epileptic syndromes.' When reporting status epilepsy with focal seizures, you'll turn to either ICD-10 code G40.1x1 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with simple partial seizers, ...with status epilepticus) or G40.2x1 (Localization-related [focal] [partial] symptomatic epilepsy and epileptic syndromes with complex partial seizures,...with status epilepticus) with the fifth ICD-10 digit indicating whether the epilepsy is intractable (5th digit = 1) or not intractable (5th digit = 0).   "This is a good example of the importance/requirement of detailed provider documentation in order to accurately code these conditions in ICD-10 where coding is based on: Localization-related versus Generalized versus Special syndromes; and within the localization-related epileptic conditions the coding is based on: Localized onset seizures versus simple partial seizures versus complex partial seizures," says Hammer. Look For One-To-One Map in Febrile and Post Traumatic Convulsions Febrile convulsions are seizures triggered by fever, although they may not occur when fever is at the highest. These convulsions are usually seen in children aged 9 months to 5 years and may run in families. When your neurologist documents fever as the trigger for seizures, choose 780.31 ( Febrile convulsions [simple], unspecified) or 780.32 (Complex febrile convulsions) depending upon whether the febrile seizures are simple or complex. "Simple febrile seizures, the most common type, can last from a few seconds to 15 minutes, do not recur within a 24-hour period and begin as a generalized tonic-clonic (grand mal) seizure and don't involve staring or shaking of just one part of the body," says Hammer. "Complex febrile seizures last longer than 15 minutes, occur more than once within 24 hours and are focal or confined to one side of the child's body." ICD-10 offers a one-to-one match for these codes. The new codes for simple and complex febrile seizures will be R56.00 ( Simple febrile convulsions) and R56.01 (Complex febrile convulsions), respectively. Similarly, when your neurologist documents an episode of trauma that seems to be a cause for the convulsions, you have a one-to-one match in ICD-9 and ICD-10. In ICD-9, you report code 780.33 ( Post traumatic seizures) and in ICD-10, you report code R56.1 (Post traumatic seizures). "To accurate report the patient's condition both ICD-9 and ICD-10 code sets require provider documentation that includes the causation of the convulsions/seizures, i.e. fever versus post trauma versus other," says Hammer. Editor's note: Read more on the ICD-10 coding of epilepsy in the next issue of Neurology and Pain Management Coding Alert.