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v1.0.0
ICD-10 Guide
ICD-10 CodesG40.1

G40.1

Billable

Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G40.1 is a billable code used to indicate a diagnosis of localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures.

Key Diagnostic Point:

G40.1 refers to a specific type of epilepsy characterized by focal or partial seizures that are symptomatic, meaning they are secondary to an identifiable cause such as a structural brain lesion, metabolic disorder, or other neurological condition. Simple partial seizures are defined by the preservation of consciousness during the episode, allowing patients to remain aware of their surroundings while experiencing abnormal motor, sensory, or autonomic phenomena. These seizures can manifest in various ways, including twitching of a limb, unusual sensations, or visual disturbances. The underlying causes of G40.1 may include traumatic brain injury, tumors, or infections, and the management often involves the use of antiepileptic drugs (AEDs) tailored to the individual's seizure type and etiology. Accurate diagnosis and classification are crucial for effective treatment and management, as well as for coding purposes, to ensure appropriate reimbursement and care continuity.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between focal and generalized seizures
  • Identifying the underlying cause of the seizures
  • Documenting the specific type of seizure experienced
  • Understanding the patient's medical history and comorbidities

Audit Risk Factors

  • Inadequate documentation of seizure type
  • Failure to specify the underlying cause of epilepsy
  • Misclassification of seizure types
  • Lack of comprehensive patient history

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed seizure descriptions, including duration, frequency, and triggers; neurological examination findings; and imaging or lab results.

Common Clinical Scenarios

Patients presenting with new-onset seizures, recurrent seizures, or seizures following a head injury.

Billing Considerations

Ensure clarity in documenting the type of seizures and any neurological deficits observed.

Epileptology

Documentation Requirements

Comprehensive seizure diaries, EEG results, and response to antiepileptic medications.

Common Clinical Scenarios

Patients undergoing evaluation for epilepsy surgery or those with refractory seizures.

Billing Considerations

Focus on the detailed characterization of seizures and their impact on daily living.

Coding Guidelines

Inclusion Criteria

Use G40.1 When
  • Follow the ICD
  • CM guidelines for coding epilepsy, ensuring to document the type of seizure and any underlying conditions
  • Include any relevant diagnostic tests and patient history to support the coding

Exclusion Criteria

Do NOT use G40.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

95816CPT Code

Electroencephalogram (EEG)

Clinical Scenario

Used to evaluate seizure activity in patients with G40.1.

Documentation Requirements

EEG report must detail findings related to seizure types and frequency.

Specialty Considerations

Neurologists should ensure EEG findings correlate with clinical symptoms.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of epilepsy types, improving the ability to track and manage epilepsy cases effectively. G40.1 provides specificity that aids in treatment planning and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of epilepsy types, improving the ability to track and manage epilepsy cases effectively. G40.1 provides specificity that aids in treatment planning and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of epilepsy types, improving the ability to track and manage epilepsy cases effectively. G40.1 provides specificity that aids in treatment planning and research.

Resources

Clinical References

  • •
    Epilepsy Foundation

Coding & Billing References

  • •
    Epilepsy Foundation

Frequently Asked Questions

What is the difference between simple partial seizures and complex partial seizures?

Simple partial seizures involve retained consciousness, while complex partial seizures involve impaired awareness. This distinction is crucial for accurate coding and treatment planning.