Have you ever lost or been denied something because of a careless mistake made by someone else?  This can easily happen to a person with an incorrect epilepsy diagnosis code in their medical record.

Medical coding is used for a variety of purposes, such as billing and reimbursement, as well as gathering and reporting statistics.  However, it can also greatly impact a person’s life outside of healthcare.  The importance of completely reviewing a patient’s record and applying the codes correctly cannot be overemphasized. 

Per the Coding Handbook, a diagnosis of epilepsy “can have serious legal and personal implications for the patient”, the most common being the inability to obtain and/or keep their driver’s license.  Can you imagine something as simple as an incorrect diagnosis code in your medical record preventing you from obtaining your driver’s license or causing you to lose it?  This is one reason why it is important to remember that these are real people and to be as accurate as possible when you review and code their chart.

Sometimes it helps to pause and go back to the basics of coding and use the Alphabetic Index to look up a diagnosis term to see the default code. Additionally, the Index will give us the terminology needed to assign a more specific code than the default or “not otherwise specified” code.  

Look up main term “seizure” in the ICD-10-CM Alphabetic Index.  Notice that:

• Seizure (without any more detail) defaults to unspecified convulsions R56.9, which is a Chapter 18 sign and symptom code.
• In order to get to a Chapter 6 Epilepsy G-code, there must be additional details in the provider’s documentation, such as the verbiage “seizure disorder”, “epilepsy”, or a specific type of epilepsy.

**This means that a diagnosis of “seizure” without any further specification should ALWAYS be reported with the default code R56.9 because it is not synonymous with epilepsy.  A person can have a seizure for a number of reasons, such as a brain tumor, infection, or injury, abnormal sodium or glucose levels, and alcohol withdrawal, and none of these equate to a “seizure disorder”. **

Coding Advice and Summary:

• Epilepsy IS NOT synonymous with seizure
• ALWAYS:
  • follow the Alphabetic Index based on the physician’s documentation
  • report codes that are supported by the physician’s documentation
• NEVER FORGET:
  • incorrect coding can actually be harmful and cause unnecessary stress for the patient
  • the epilepsy code will become part of their permanent medical record and can be used in legal proceedings
  • an epilepsy diagnosis code can cause a patient to lose their driver’s license and/or prevent them from obtaining one.
• NEVER ASSUME and code as Epilepsy if:
  • you see “seizures” or “convulsions” in the documentation, especially if only notated in the patient’s past medical condition, regardless if they are on medications for it or not
  • if they are taking seizure prophylactic medicine to prevent seizures
• ONLY report a code for Epilepsy if:
  • the doctor has diagnosed epilepsy, “seizure disorder”, or a specific type of epilepsy that can be indexed to a Chapter 6 code

Tarah  Lee, CCS

LexiCode Quality Assurance Analyst

References:

• Coding Clinic 1^st Q 2008 page 17
• Coding Clinic 3^rd Q 1994 page 9
• Coding Clinic 1^st Q 1993 page 24
• AHA Coding Handbook ~ 17 Diseases of the Nervous System and Sense Organs ~ Epilepsy
• https://library.ahima.org/doc?oid=104008