ICD-10 Coding for Status Epilepticus(G40.301, R56.1)
Complete ICD-10-CM coding and documentation guide for Status Epilepticus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Status Epilepticus
G40.3-G40.9Primary Range
Epilepsy and recurrent seizures
This range includes codes for various types of epilepsy, including those with 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 |
|---|---|---|---|
| G40.301 | Generalized idiopathic epilepsy, not intractable, with status epilepticus | For generalized tonic-clonic seizures with status epilepticus in non-intractable cases. |
|
| R56.1 | Post-traumatic seizures | Use when seizures are directly related to recent trauma. |
|
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 status epilepticus
Essential facts and insights about Status Epilepticus
Primary ICD-10-CM Codes for status epilepticus
Decision Criteria
clinical Criteria
- Presence of generalized tonic-clonic seizures lasting >5 minutes
documentation Criteria
- EEG confirmation of generalized spike-wave activity
Applicable To
- Generalized tonic-clonic status epilepticus
Excludes
- Epileptic spasms (G40.82-)
Clinical Validation Requirements
- EEG showing generalized spike-wave activity
- Seizure duration >5 minutes
Code-Specific Risks
- Misclassification if intractability is not assessed
Coding Notes
- Ensure documentation specifies seizure type and intractability.
R56.1 - Post-traumatic seizures
Use when seizures are directly related to recent trauma.
Applicable To
- Seizures following head trauma
Excludes
- Epilepsy (G40.-)
Clinical Validation Requirements
- History of recent head trauma
- Seizure onset post-injury
Coding Notes
Ensure trauma is documented as the cause of seizures.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Noncompliance with AED regimen
Z91.83Differential 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 Status Epilepticus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.301.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use specific terminology, Document EEG findings
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding standards., Data Quality: Reduces accuracy of patient records.
Mitigation Strategy
Use specific codes such as G40.301 for generalized epilepsy with status.
Impact
High risk of audit if unspecified codes are used when specific codes are applicable.
Mitigation Strategy
Train staff to use specific codes and ensure documentation supports code selection.
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 Status Epilepticus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Status Epilepticus
Use these documentation templates to ensure complete and accurate documentation for Status Epilepticus. These templates include all required elements for proper coding and billing.
Admission for Status Epilepticus
Specialty: NeurologyRequired Elements
- Seizure type and duration
- EEG findings
- Medication response
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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