Neurology & Pain Management Coding Alert

Question: Encounter notes indicate that a patient suffers from “epilepsy w/grand mal on waking.” There are a lot of ICD-10-CM codes for epilepsy, but I cannot find one that matches this description. Can you help?

Massachusetts Subscriber

Answer: This patient is suffering from epilepsy with grand mal seizures upon awakening. Unfortunately, there is not a specific diagnosis code for this condition. You’ll have to report a code from the G40.4- (Other generalized epilepsy and epileptic syndromes) subcategory.

Character concerns: The G40.4- codes require 5^th and 6^th characters in order to complete the diagnosis. The 5^th character indicates whether the patient’s epilepsy is not intractable or intractable. Use the 6^th character to indicate whether the patient has status epilepticus.

So, if a patient suffered from grand mal seizures upon awakening that were not intractable with status epilepticus, you would report G40.401 (Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus).

Know alternate terms: You should use the G40.4- subcategory as your root diagnosis when the physician lists epilepsy with grand mal seizures upon awakening; you should also report a code from G40.4- when the patient is suffering from one of the following conditions:

• Epilepsy with myoclonic absences
• Epilepsy with myoclonic-astatic seizures
• Grand mal seizure NOS
• Nonspecific atonic epileptic seizures
• Nonspecific clonic epileptic seizures
• Nonspecific myoclonic epileptic seizures
• Nonspecific tonic epileptic seizures
• Nonspecific tonic-clonic epileptic seizures
• Symptomatic early myoclonic encephalopathy.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC