Coding of Seizures and Epilepsy

Gregory L. Barkley, MD
Vice President
National Association of Epilepsy Centers

Powerpoint Presentation

Slide 1

Coding of Seizures and Epilepsy

Gregory L. Barkley, MD
Vice President
National Association of Epilepsy Centers

Slide 2

Seizure - 780.39

• A seizure is a paroxysmal behavioral spell generally caused by an excessive disorderly discharge of cortical nerve cells
• Epileptic seizures range from clinically undetectable ("electrographic seizures") to convulsions.
• The symptoms vary depending upon the part of the brain involved in the epileptic discharge
• Most seizures last for about 1 minute

Slide 3

Epilepsy - 345

• Epilepsy is a syndrome of two or more unprovoked or recurrent seizures on more than one occasion
• Epileptic syndromes are characterized by:
  • The behavior during the seizure(s) (semiology)
  • The age of onset
  • Etiology, if known
  • EEG characteristics of the seizure type(s)

Slide 4

Intractability

• Fifth digit subclassification
  • 0 without mention of intractable epilepsy
  • 1 with intractable epilepsy
    • pharmacoresistant (pharmacologically resistant)
    • treatment resistant
    • refractory (medically or surgically)
    • poorly controlled
    • breakthrough
    • exacerbation of seizures

Slide 5

Recurrent Seizures 345.X1

• Term is used to indicate a patient with epilepsy who had previously controlled seizures who has had a return of seizures or that the rate of seizures has increased in that patient
• Some physicians, especially emergency physicians substitute the term "exacerbation of seizures" by analogy to asthma coding

Slide 6

Breakthrough Seizure - 345.X1

• This term is given to patients with epilepsy who have not had a seizure for a long interval and then had another seizure
• Synonym to recurrent seizure
  • Implied by usage is that the patient has had epileptic seizures previously, thus recurrent seizures or epilepsy

Slide 7

Repetitive Seizures - 780.39

• This term is given when a patient has several seizures in a short period of time
• In a patient without a history of epilepsy, the most common cause is acute symptomatic seizures as a response to a central nervous system derangement
  • Acute stroke, acute head injury, acute alcohol withdrawal
• Repetitive seizures could occur in patients with epilepsy, in which case, the code would be 345.x1

Slide 8

Non-Epileptic Seizures I

• There are many paroxysmal behavioral spells that resemble epileptic seizures.
• Sometimes impossible to distinguish from epileptic seizures without video EEG monitoring

Slide 9

Non-Epileptic Seizures II

• Many causes
• Cardiac - syncope, dysrrhythmias
• Endocrine - hypoglycemia
• Sleep disorders - Sleep apnea, REM behavior disorder
• Neurologic - tics, myoclonus, frontotemporal dementia
• Psychologic - panic attacks, autistic behaviors, etc.

Slide 10

Non-Epileptic Seizures III

• We propose to add the index terms under Seizures
  • Non-epileptic - 780.39
  • Psychogenic - 780.39
• For psychogenic non-epileptic seizures
  • We propose that a secondary psychiatric diagnostic code be used

Slide 11

Acute Symptomatic Seizures vs. Late onset Epilepsy

• Early seizures after acute brain derangement are symptomatic of the disturbance of brain function and do not predict the later development of epilepsy
  • Trauma, stroke, encephalitis, alcohol withdrawal
• Seizures beginning weeks to years later represent the development of epilepsy as a late effect and coded as such, 907.0, 438.9, 139.0

Classification Sources

Data Resources

National Center for Health Statistics
3311 Toledo Road
Hyattsville, MD 20782
Phone:
1-800-232-4636
cdcinfo@cdc.gov

Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, U.S.A
Tel: (404) 639-3311 / Public Inquiries: (404) 639-3534 / (800) 311-3435