G40.019
BillableLocalization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
HCC Category Mapping
V28HCC 201 — Seizure Disorders and Convulsions
0.262V24HCC 79 — Seizure Disorders and Convulsions
0.244ESRDHCC 79 — Seizure Disorders and Convulsions
0.000RxHCCHCC 163 — Seizure Disorders, Intractable Epilepsy
0.000What This Code Means
This is a type of epilepsy that starts in a specific area of the brain and cannot be controlled with medication. The person experiences seizures that begin in one location but the condition is difficult to treat.
Coding Tips
- •Verify documentation confirms the epilepsy is idiopathic (no known cause), localization-related, and intractable (drug-resistant) before assigning this code
- •Ensure the documentation explicitly states 'without status epilepticus' or does not mention status epilepticus; if status epilepticus is present, use G40.011 instead
Clinical Significance
This code captures focal idiopathic epilepsy that is drug-resistant (intractable) but the patient is not currently in status epilepticus. It identifies patients whose seizures continue despite adequate medication trials, indicating higher baseline complexity and ongoing management challenges. These patients may be candidates for epilepsy surgery or neuromodulation devices.
Documentation Requirements
- ✓Documentation confirming focal (localization-related) idiopathic epilepsy
- ✓Documentation of intractable status including failed medication trials
- ✓List of antiepileptic medications tried and reasons for failure or switching
- ✓Current seizure frequency and types
- ✓Confirmation that patient is NOT currently in status epilepticus
- ✓Evaluation for surgical candidacy or other advanced interventions if applicable
Commonly Confused Codes
G40.009 — Same type, NOT intractable, without status epilepticus; well-controlled versionG40.011 — Same type, intractable, WITH status epilepticus; acute emergency presentationG40.119 — Symptomatic focal epilepsy, intractable; has an identified structural causeG40.319 — Generalized idiopathic epilepsy, intractable; generalized rather than focal onsetG40.919 — Epilepsy unspecified, intractable; less specific
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└G40.019Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus
└G40.019Localization-related (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures of localized onset, intractable, without status epilepticus