F44.5
BillableConversion disorder with seizures or convulsions
HCC Category Mapping
RxHCCHCC 133 — Personality Disorders, Anxiety, and Other Specified Mental Disorders
0.000What This Code Means
A condition where psychological distress manifests as seizures or convulsions that mimic epilepsy but have no underlying neurological cause.
Coding Tips
- •Document EEG findings or neurological evaluation confirming non-epileptic nature
- •Differentiate from true seizure disorders by noting absence of typical EEG abnormalities
Clinical Significance
Conversion disorder with seizures or convulsions (psychogenic non-epileptic seizures, or PNES) involves seizure-like episodes that are not caused by epileptic activity. PNES accounts for approximately 20-30% of patients referred to epilepsy centers. Misdiagnosis can lead to unnecessary anticonvulsant medications with their associated side effects and risks. Accurate diagnosis typically requires video-EEG monitoring.
Documentation Requirements
- ✓Seizure-like episodes described with motor, behavioral, or experiential features
- ✓Video-EEG monitoring results showing no epileptiform activity during captured events (gold standard)
- ✓Clinical features inconsistent with epileptic seizures (e.g., prolonged duration, fluctuating course, asynchronous movements, eye closure during events, preserved awareness during bilateral convulsive movements)
- ✓Symptom causes clinically significant distress or functional impairment
- ✓Neurological evaluation ruling out epilepsy
- ✓Assessment for comorbid conditions (PTSD, depression, anxiety, history of abuse)
Commonly Confused Codes
G40.909 (Epilepsy, unspecified, not intractable, without status epilepticus) — True epilepsy confirmed by EEG; F44.5 is for non-epileptic eventsF44.4 (Conversion disorder with motor symptom or deficit) — Use F44.4 for motor deficits (weakness, paralysis) without seizures; F44.5 is specifically for seizure presentationsG40.89 (Other seizures) — Use for seizures with an organic basis but not meeting specific epilepsy criteriaR56.9 (Unspecified convulsions) — Symptom code for convulsions before definitive diagnosis; use F44.5 once PNES is confirmed
Code Hierarchy
└F44Dissociative and conversion disorders└F44.5Conversion disorder with seizures or convulsions
└F44.5Conversion disorder with seizures or convulsions