EmailPostictal state/confusion
Publication Date: September 2016
ICD 10 AM Edition: Ninth edition
Query Number: 3110
We would like to seek clarification on guidance for postictal state and confusion. This condition is frequently documented with non epileptic or undiagnosed epileptic seizures. For example, seizure with postictal confusion.
Mosby's medical dictionary defines postictal as 'following a seizure' no specification of epileptic. However the Coding Rules , December 2012 only specifically mentions postictal state/confusion following an epileptic seizure and the pathway has the descriptor 'epileptic. This pathway has not been amended since the release of this advice.
The rule also states:
Where postictal state is documented without further specification, assign G40.90 Epilepsy, unspecified, without mention of intractable epilepsy. This phrase states that postictal state should be coded as epilepsy, even when epilepsy is not documented. This would have the potential to see many non epileptic patients coded as epileptic.
Clinical advice we have sought states that this state/confusion can arise in seizures in a non epileptic patient such as hypoglycaemic , alcoholic or hyponatraemic seizures (excluding psychogenic and pseudoseizures).
1. Should epilepsy be automatically coded if the postictal state is documented in these cases?
2. If postictal confusion is documented should F05.8 Other Delirium still be assigned even where there is no documentation of epileptic seizures or epilepsy?
Mosby's medical dictionary defines postictal as 'following a seizure' no specification of epileptic. However the Coding Rules , December 2012 only specifically mentions postictal state/confusion following an epileptic seizure and the pathway has the descriptor 'epileptic. This pathway has not been amended since the release of this advice.
The rule also states:
Where postictal state is documented without further specification, assign G40.90 Epilepsy, unspecified, without mention of intractable epilepsy. This phrase states that postictal state should be coded as epilepsy, even when epilepsy is not documented. This would have the potential to see many non epileptic patients coded as epileptic.
Clinical advice we have sought states that this state/confusion can arise in seizures in a non epileptic patient such as hypoglycaemic , alcoholic or hyponatraemic seizures (excluding psychogenic and pseudoseizures).
1. Should epilepsy be automatically coded if the postictal state is documented in these cases?
2. If postictal confusion is documented should F05.8 Other Delirium still be assigned even where there is no documentation of epileptic seizures or epilepsy?
Response
In response to question one, VICC advises that epilepsy should only be coded for documentation of postictal state in an epileptic patient. In response to question two, F05.8 Other delirium should be assigned when postictal confusion is documented in an epileptic patient.
VICC advises that the Coding Rules advice noted in the query only applies to postictal state following an epileptic seizure.
For documentation of postictal state, without documentation of epilepsy VICC advises to assign:
R56.8 Other and unspecified convulsions as the default at Lead term Seizure(s)
For documentation of postictal confusion, VICC advises to assign:
R41.0 Disorientation, unspecified as the default at Lead term Confusion; and
R56.8 Other and unspecified convulsions as the default at Lead term Seizure(s)
VICC advises that the Coding Rules advice noted in the query only applies to postictal state following an epileptic seizure.
For documentation of postictal state, without documentation of epilepsy VICC advises to assign:
R56.8 Other and unspecified convulsions as the default at Lead term Seizure(s)
For documentation of postictal confusion, VICC advises to assign:
R41.0 Disorientation, unspecified as the default at Lead term Confusion; and
R56.8 Other and unspecified convulsions as the default at Lead term Seizure(s)
