Q&A: Seizures and epilepsy

Q: In the case of documentation for a patient that had a hemorrhagic stroke and then a seizure, without pre-existing seizure disorder, are there coding rules to help with sequencing? Would it be appropriate to code epilepsy? What if the documentation describes a tonic clonic seizure, can we take that to grand mal seizure that then codes to epilepsy?

A: The 2021 ICD-10-CM Alphabetic Index contains inclusion terms for G40.4, other generalized epilepsy and epileptic syndromes. Grand mal seizure not otherwise specified (NOS) is included in the term epilepsy. Non-specific tonic clonic seizures is also an inclusion term. So, either term maps to the same code of G40.4. 

Clinically, epilepsy is diagnosed based on the occurrence of two or more seizures, and this patient reportedly has no history of seizure activity. Seizures do not get classified as epilepsy unless the seizures are recurrent. Convulsions (R56) contains an Excludes 1 note for epileptic convulsions and seizures, and vice versa.

As a CDI professional the opportunity would be to clarify the type of seizure with the provider through the query process.

Lastly, as a CDI professional you’ll want to determine the circumstances of how the hemorrhage started. If trauma-related, code R56.1 Post traumatic seizures may be appropriate depending on the circumstances outlined in the documentation.

Editor’s Note: Dawn Valdez, RN, LNC, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at dvaldez@hcpro.com. For information regarding CDI Boot Camps, click here.