ICD Code G40.909

ICD code G40.909 is used to classify a diagnosis of epilepsy that is unspecified in nature, meaning the specific type of epilepsy is not detailed. It indicates that the epilepsy is not intractable, which means it is generally manageable and responsive to treatment. Additionally, this code specifies that the patient is not experiencing status epilepticus, a condition where seizures follow one another without recovery of consciousness in between. This code helps healthcare providers document and communicate the patient's condition accurately for treatment planning and billing purposes.

1. Recurrent Seizures: The patient experiences two or more unprovoked seizures, which are not triggered by identifiable factors such as fever, infection, or acute illness.

2. Absence of Status Epilepticus: The patient does not experience prolonged or repeated seizures without recovery between them, which would otherwise indicate status epilepticus.

3. Non-Intractable Condition: The seizures are manageable and respond well to standard treatment options, indicating that the condition is not resistant to therapy.

4. Unspecified Epilepsy Type: The specific type of epilepsy is not determined or documented, meaning it does not fall into a more specific category such as focal or generalized epilepsy.

5. Clinical Evaluation: Diagnosis is supported by clinical evaluation, including patient history and neurological examination, but without specific findings that classify the epilepsy into a more detailed category.

6. Exclusion of Other Causes: Other potential causes for the seizures, such as metabolic disturbances, structural brain lesions, or acute medical conditions, have been ruled out.

7. Documentation in Medical Records: The diagnosis is clearly documented in the patient's medical records, reflecting the unspecified nature of the epilepsy and the absence of intractability or status epilepticus.

For the ICD code G40.909, which pertains to epilepsy, unspecified, not intractable, without status epilepticus, the relevant CPT codes that may be applicable for treatment and management include:

1. 99201-99205 - New patient office or other outpatient visit codes, depending on the complexity and time spent.

2. 99211-99215 - Established patient office or other outpatient visit codes, depending on the complexity and time spent.

3. 95812 - Electroencephalogram (EEG) extended monitoring; 41-60 minutes.

4. 95813 - Electroencephalogram (EEG) extended monitoring; greater than 1 hour.

5. 95816 - Electroencephalogram (EEG); awake and drowsy.

6. 95819 - Electroencephalogram (EEG); awake and asleep.

7. 95950 - Ambulatory EEG monitoring.

8. 95951 - EEG monitoring during sleep.

9. 96116 - Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual-spatial abilities), per hour of the psychologist’s or physician’s time, both face-to-face time with the patient and time interpreting test results and preparing the report.

10. 96132 - Neuropsychological testing evaluation services by physician or other qualified healthcare professional, per hour.

These CPT codes are commonly used in the diagnosis, evaluation, and management of epilepsy and related neurological conditions. It is important for healthcare providers to select the appropriate CPT codes based on the specific services rendered and the clinical scenario.

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