ICD-10 Coding for Tonic-Clonic Seizure(G40.4xx, G40.5xx)
Complete ICD-10-CM coding and documentation guide for Tonic-Clonic Seizure. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tonic-Clonic Seizure
G40.4-G40.5Primary Range
Epilepsy and recurrent seizures
This range includes codes for generalized epilepsy and recurrent seizures, which encompass tonic-clonic seizures.
Convulsions, not elsewhere classified
This range includes codes for convulsions that are not classified under epilepsy, such as single seizures.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G40.4xx | Other generalized epilepsy and epileptic syndromes | Use for patients with confirmed epilepsy experiencing generalized tonic-clonic seizures. |
|
| G40.5xx | Epileptic seizures related to external causes | Use when seizures are directly related to substance use. |
|
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 tonic clonic seizure
Essential facts and insights about Tonic-Clonic Seizure
Primary ICD-10-CM Codes for tonic clonic seizure
Decision Criteria
clinical Criteria
- Patient has experienced two or more unprovoked seizures.
documentation Criteria
- EEG findings support generalized epilepsy.
Applicable To
- Generalized tonic-clonic seizures without status epilepticus
Excludes
- Focal seizures with secondary generalization
Clinical Validation Requirements
- ≥2 unprovoked seizures
- EEG showing generalized spike-wave activity
Code-Specific Risks
- Misclassification if epilepsy is not confirmed
Coding Notes
- Ensure documentation specifies 'generalized tonic-clonic' and confirms epilepsy diagnosis.
G40.5xx - Epileptic seizures related to external causes
Use when seizures are directly related to substance use.
Applicable To
- Drug-induced seizures
- Alcohol-induced seizures
Excludes
- Seizures due to acute intoxication
Clinical Validation Requirements
- Documentation of substance use as a cause
Coding Notes
Sequence substance use disorder code before G40.5xx.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Patient's noncompliance with medical treatment and regimen
Z91.41Differential 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 Tonic-Clonic Seizure to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G40.4xx.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Fails to meet documentation standards., Financial: May result in claim denials.
Mitigation Strategy
Educate providers on the importance of specifying seizure types.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Use R56.9 for single seizures without epilepsy diagnosis.
Impact
Inadequate documentation of seizure type can lead to audit issues.
Mitigation Strategy
Implement standardized templates for seizure documentation.
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 Tonic-Clonic Seizure, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tonic-Clonic Seizure
Use these documentation templates to ensure complete and accurate documentation for Tonic-Clonic Seizure. These templates include all required elements for proper coding and billing.
Generalized Tonic-Clonic Seizure Documentation
Specialty: NeurologyRequired Elements
- Seizure type
- Intractability
- Status epilepticus
- Triggers
- Post-ictal state
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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