# Presentation: 711174

## Coding of Seizures and Epilepsy

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

## 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

## 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)‏

## 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

## 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

## 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

## 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

## 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

## 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.

## 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

## 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