G40.011

Billable

Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus

HCC Category Mapping

V28HCC 201 — Seizure Disorders and Convulsions

0.262

V24HCC 79 — Seizure Disorders and Convulsions

0.244

ESRDHCC 79 — Seizure Disorders and Convulsions

0.000

RxHCCHCC 163 — Seizure Disorders, Intractable Epilepsy

0.000

What This Code Means

A type of epilepsy that starts in one area of the brain with no known cause, is difficult to control with medication, and the patient is currently experiencing prolonged seizure activity (status epilepticus).

Coding Tips

•The '01' indicates idiopathic (no known cause) and the final '1' indicates intractable with status epilepticus; ensure all three components are documented
•Status epilepticus is a medical emergency; verify this acute condition is documented separately if applicable

Clinical Significance

This code captures the most severe presentation of focal idiopathic epilepsy — drug-resistant and currently in status epilepticus. It represents a neurological emergency in a patient whose seizures are already difficult to control. These patients require intensive care management and carry significantly higher morbidity and mortality risk, warranting accurate coding for resource allocation.

Documentation Requirements

✓Documentation confirming focal (localization-related) idiopathic epilepsy
✓Documentation of intractable status — multiple medication failures or drug-resistant epilepsy
✓Active status epilepticus documented with onset time and interventions
✓List of failed antiepileptic medications supporting the intractable designation
✓EEG monitoring results if available
✓Emergency treatment protocol and response documentation

Commonly Confused Codes

G40.019 — Same type, intractable, WITHOUT status epilepticus; use when not in active status epilepticus G40.001 — Same type, NOT intractable, with status epilepticus; when seizures are normally controlled G40.111 — Symptomatic focal epilepsy, intractable, with status epilepticus; has an identified cause G40.311 — Generalized idiopathic epilepsy, intractable, with status epilepticus; generalized rather than focal G40.009 — Same type, not intractable, without status epilepticus; stable well-controlled state

Code Hierarchy

└G40Epilepsy and recurrent seizures └G40.0Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset └G40.01Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable └G40.011Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus

└G40.011Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, with status epilepticus