G40.111

HCC Category Mapping

What This Code Means

This is a type of epilepsy where seizures start in one specific area of the brain and cannot be controlled with medication, and the patient is currently experiencing status epilepticus (prolonged or repeated seizures without full recovery between them). The seizures involve simple partial symptoms, meaning the person remains conscious during the seizure.

Coding Tips

• •Verify documentation confirms the epilepsy is intractable (drug-resistant) and that status epilepticus is currently present, as both components are required for this specific code
• •Distinguish between simple partial seizures (consciousness retained) and complex partial seizures, as they have different code assignments; also confirm the localization-related nature is documented

Clinical Significance

This code captures the most clinically severe scenario for symptomatic focal epilepsy with simple partial seizures — both drug-resistant and in active status epilepticus. These patients have failed multiple medications and are experiencing a life-threatening prolonged seizure emergency. Accurate coding reflects the extreme complexity and resource intensity of managing these cases.

Documentation Requirements

• ✓Documentation of symptomatic focal epilepsy with a known underlying cause
• ✓Simple partial seizure type documented (consciousness preserved)
• ✓Evidence of intractable status with documented medication failures (at least 2 adequate trials)
• ✓Active status epilepticus with emergency treatment documentation
• ✓Underlying structural or metabolic cause identified and coded separately
• ✓ICU admission documentation if applicable

Commonly Confused Codes