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ICD-10 Guide
ICD-10 CodesG93.45

G93.45

Billable

Developmental and epileptic encephalopathy

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

Code Description

ICD-10 G93.45 is a billable code used to indicate a diagnosis of developmental and epileptic encephalopathy.

Key Diagnostic Point:

Developmental and epileptic encephalopathy (DEE) is a group of severe neurological disorders characterized by developmental delays, cognitive impairment, and intractable seizures. These conditions often manifest in early childhood and are associated with a range of symptoms that can include intellectual disability, behavioral issues, and various forms of epilepsy. The pathophysiology of DEE is complex, often involving genetic mutations, structural brain abnormalities, and metabolic dysfunctions. Patients may experience a variety of comorbidities, including pain syndromes, autonomic disorders, and hydrocephalus, which can complicate their clinical management. The diagnosis typically requires a comprehensive evaluation, including neuroimaging, genetic testing, and electroencephalography (EEG) to assess seizure activity. Treatment is multidisciplinary, focusing on seizure control, developmental support, and addressing associated symptoms. The prognosis varies widely depending on the underlying cause and the severity of the condition, making early diagnosis and intervention crucial for improving outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of associated symptoms and comorbidities
  • Need for comprehensive diagnostic testing
  • Potential for multiple underlying genetic causes
  • Variability in clinical presentation

Audit Risk Factors

  • Inconsistent documentation of symptoms
  • Failure to document comorbid conditions
  • Lack of clarity in diagnostic testing results
  • Inadequate justification for the use of this specific code

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological assessments, including seizure types, frequency, and developmental milestones.

Common Clinical Scenarios

Patients presenting with developmental delays and seizures, requiring EEG and neuroimaging.

Billing Considerations

Ensure comprehensive documentation of all neurological evaluations and interventions.

Pediatrics

Documentation Requirements

Growth and developmental assessments, family history, and psychosocial evaluations.

Common Clinical Scenarios

Children with unexplained developmental delays and seizures, requiring multidisciplinary evaluations.

Billing Considerations

Document any referrals to specialists and the outcomes of those evaluations.

Coding Guidelines

Inclusion Criteria

Use G93.45 When
  • According to ICD
  • 10 guidelines, G93
  • 45 should be used when the clinical documentation supports a diagnosis of developmental and epileptic encephalopathy
  • It is essential to ensure that all relevant symptoms and comorbidities are documented to justify the use of this code

Exclusion Criteria

Do NOT use G93.45 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 DEE.

Documentation Requirements

Document the indication for the EEG and findings.

Specialty Considerations

Neurologists should ensure that EEG interpretations are clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of complex conditions like DEE, improving the accuracy of diagnoses and facilitating better patient management through detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of complex conditions like DEE, improving the accuracy of diagnoses and facilitating better patient management through detailed documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of complex conditions like DEE, improving the accuracy of diagnoses and facilitating better patient management through detailed documentation.

Resources

Clinical References

  • •
    CDC - Developmental Disabilities

Coding & Billing References

  • •
    CDC - Developmental Disabilities

Frequently Asked Questions

What are the key symptoms of developmental and epileptic encephalopathy?

Key symptoms include developmental delays, intractable seizures, cognitive impairment, and behavioral issues. Patients may also experience associated conditions such as pain syndromes and autonomic dysfunction.