Reporting Epilepsy and Seizures with Medical Codes

Hello everyone and welcome to our podcast series.

My name is Natalie Tornese and I’m a Senior Solutions Manager at Outsource Strategies International. I want to take this opportunity to talk to you about epilepsy and seizures.

Epilepsy is a common neurological disorder marked by recurrent, unprovoked seizures. Although the two terms, epilepsy and seizures, are often used interchangeably, a seizure is a single occurrence and is different from epilepsy.

Epilepsy constitutes two or more unprovoked seizures.  Epilepsy affects both males and females of all ages, races and ethnic backgrounds. The disorder can develop from a brain injury, stroke, brain cancer, and drug or alcohol abuse, although the cause of disorder in many patients may be unknown.

The John Hopkins Epilepsy Center defines a seizure as “a sudden, electrical discharge in the brain causing alterations in behavior, sensation, or consciousness”. Excessive and abnormal cortical nerve cell activity in the brain causes seizures. Seizures are classified as generalized and partial. Generalized seizures are seizures that appear to begin everywhere in the brain at once. There are 6 main types of generalized seizures: Tonic-clonic, Tonic, Clonic, Myoclonic, Absence, and Atonic. Seizures beginning in one location of the brain are termed partial seizures.

Status epilepticus (SE) is a medical emergency where the brain is in a state of persistent seizure. It is a condition which can have long-term consequences including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.

Epilepsy signs and symptoms vary depending on the type of seizure and may include temporary confusion, a staring spell, uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness and psychic symptoms such as fear, anxiety or déjà vu. As a person with epilepsy will usually experience the same type of seizure each time, the symptoms may not be similar from episode to episode.

Epilepsy is diagnosed through neurological exams, blood tests and tests to detect brain abnormalities such as high-density EEG, PET scans, MRI, SPECT scans, neuropsychological tests as well as analysis techniques to help identify the origin of the brain seizures.

Epilepsy is initially treated with medication. If medications fail to control the seizures, physicians will propose surgery or other types of treatment.  Epilepsy surgery involves removing the area of your brain that is causing the seizures. Other treatment options include vagus nerve stimulation, adapting to a ketogenic diet, and deep brain stimulation.

Intractable epilepsy is a disorder in which seizures fail to come under control with treatment. These seizures are also called “uncontrolled seizures” or “refractory seizures.”

The ICD-10 coding for epilepsy is available under G00-G99 Diseases of the nervous system, G40-G47 Episodic and paroxysmal disorders. The code descriptions include intractable or not intractable, as well as with or without status epilepticus.

Insurance companies may cover epilepsy exams/tests, treatments, medications, and surgeries that are clearly documented as medically necessary. I will include documentation along with this podcast that is specific coding related to epilepsy treatment.

I hope this helps, but always remember that documentation and a thorough knowledge of pay regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!