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December 11, 2006
Seizures are abnormal electrical signals in the brain that prevent other brain cells from working properly. A majority of the patients who experience a seizure will never experience another. In contrast, epilepsy is a chronic brain disorder that causes recurrent seizures. Also documented as seizure disorder, epilepsy causes a short-term change in sensation, behavior, movement, or consciousness. Most commonly diagnosed in children or people over the age of 65, epilepsy is often caused by accidents, diseases, or a medical trauma such as a stroke. However, in many cases, the cause of epilepsy is unknown. Types of Epilepsy • Simple partial seizures (345.5x) begin in a small area of the brain with no loss of consciousness. Symptoms include uncontrolled shaking of a body part and altered emotions. • Complex partial seizures (345.4x) begin in a small area of the brain with altered consciousness. Symptoms include amnesia, staring, and nonpurposeful movements. • Secondary generalized seizures/partial seizures with secondary generalization (345.4x) spread to the entire brain and become more intense, leading to generalized convulsions. Symptoms include stiffening and shaking of the extremities or body with loss of consciousness. • Absence (petit mal) seizures (345.0x) are brief attacks characterized by staring, subtle body movements, and alteration of awareness. Petit mal status or absence status is characterized by recurrent attacks without alleviation between seizures and is assigned to code 345.2. • Myoclonic seizures (345.1x) are characterized by sudden jerks of the arms and legs. • Atonic seizures (345.0x) are the same as petit mal seizures. • Generalized tonic-clonic (grand mal) seizures (345.1x) are the most intense seizures characterized by loss of consciousness, body stiffening, body shaking, tongue biting, and loss of bladder control followed by confusion or sleepiness. Grand mal status (345.3) involves recurrent attacks without alleviation between seizures. Also documented as status epilepticus, grand mal status is a medical emergency because the recurrent attacks cause intense muscle contractions, leaving the patient unable to breathe properly. A fifth-digit subclassification is required with most codes in category 345. The fifth digit identifies the presence or absence of intractable epilepsy. Codes 345.2 (petit mal status) and 345.3 (grand mal status) do not require a fifth digit. Many other types of seizures are diagnosed based on the trigger, behavior during the seizure, and brain wave patterns. Identification of the type will predict the patient’s prognosis and identify which treatment is most effective. Some of the more common types include the following: • Febrile seizures are triggered by a high fever
in young children. Simple febrile seizures/convulsions or febrile seizures,
not otherwise specified (NOS) are classified to code 780.31. Complex
febrile seizure/convulsion is classified to code 780.32. AHA Coding Clinic for ICD-9-CM Index and Tabular
List Update • Recurrent seizures NOS; and • Seizure disorder NOS. Therefore, if the physician documents seizure disorder or recurrent seizures, code 345.90 is assigned. Prior to October 1, documentation of seizure disorder or recurrent seizures was classified to code 780.39. This recent directive change takes precedence over advice previously published in AHA Coding Clinic for ICD-9-CM which stated a code for epilepsy should not be assigned unless the physician specifically states epilepsy as a condition in the diagnostic statement (1993, first quarter, page 24; 1992, fourth quarter, pages 23-24; 1992, second quarter, page 8). The terms that remain classified to code 780.39 include convulsive disorder NOS, fit NOS, recurrent convulsions NOS, and seizure NOS. Diagnosis • physical and neurological exam; • blood tests to check for chemical imbalances; • electroencephalogram, which records electrical activity of the brain (The results of the diagnostic study may determine the type of seizure or epilepsy and in what part of the brain the seizure started.); • computed tomography scan to reveal brain structure abnormalities; and • magnetic resonance imaging to reveal abnormalities in the brain structure. Treatment • phenytoin (Dilantin, Phenytek); • carbamazepine (Carbatrol, Tegretol); • valproic acid (Depakene); • divalproex (Depakote); • levetiracetam (Keppra); • gabapentin (Neurontin); • phenobarbital; • ethosuximide (Zarontin); • clonazepam (Klonopin); • primidone (Mysoline); • pxcarbazepine (Trileptal); • lamotrigine (Lamictal); • topiramate (Topamax); • felbamate (Felbatol); • tiagabine (Gabitril); and • zonisamide (Zonegran). Coding and sequencing for epilepsy are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey
Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a
business of 3M Health Information Systems, a supplier of coding and
classification systems to nearly 5,000 healthcare providers. The company
and its representatives do not assume any responsibility for reimbursement
decisions or claims denials made by providers or payors as the result
of the misuse of this coding information. More information about 3M
Health Information Systems is available at www.3mhis.com or by calling
800-367-2447.
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