ICD Code G40.919

ICD code G40.919 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 intractable, which means it is resistant to treatment and difficult to control with standard therapies. Additionally, this code specifies that the patient is not experiencing status epilepticus, a condition where seizures follow one another without recovery of consciousness between them. This code is crucial for healthcare providers to accurately document and manage the treatment of patients with challenging epilepsy cases.

1. Recurrent Seizures: The patient experiences two or more unprovoked seizures, which are not caused by an identifiable medical condition or temporary factor.

2. Intractability: The seizures are classified as intractable, meaning they are resistant to treatment and do not respond adequately to at least two appropriate anti-seizure medications.

3. Absence of Status Epilepticus: The patient does not experience status epilepticus, which is a condition where seizures follow one another without recovery of consciousness between them, or a single seizure lasts more than five minutes.

4. Unspecified Epilepsy Type: The specific type of epilepsy is not determined or classified, indicating that the seizures do not fit into a more specific category of epilepsy.

5. Clinical Evaluation: The diagnosis is supported by clinical evaluation, including patient history, neurological examination, and possibly diagnostic tests such as EEG or neuroimaging, to rule out other causes of seizures.

6. Documentation: The patient's medical records should clearly document the frequency, duration, and characteristics of the seizures, as well as the treatment history and response to medications.

For the ICD code G40.919, the relevant CPT codes that may be applicable include:

1. 99201-99205 - New patient office or other outpatient visit for the evaluation and management of a patient.

2. 99211-99215 - Established patient office or other outpatient visit for the evaluation and management of a patient.

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

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

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

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

7. 95950 - Ambulatory electroencephalogram (EEG) monitoring.

8. 95951 - Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (e.g., for presurgical localization), each 24 hours.

9. 95953 - Monitoring for localization of cerebral seizure focus by cable or radio, 8 or more channel telemetry, combined electroencephalographic (EEG) and video recording and interpretation (e.g., for presurgical localization), each 24 hours.

10. 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.

These CPT codes are commonly associated with the evaluation, management, and treatment of conditions related to the ICD code G40.919. It is important for healthcare providers to verify the specific services rendered and ensure accurate coding for reimbursement purposes.

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