G40.219
BillableLocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, 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
A type of epilepsy that starts in one area of the brain and causes complex partial seizures that are difficult to control with medication, but the patient is not currently in status epilepticus.
Coding Tips
- •The '9' in the fifth character indicates absence of status epilepticus, which is the key distinction from G40.211
- •Document the frequency and severity of breakthrough seizures despite medication compliance to support the intractable diagnosis
Clinical Significance
This code captures symptomatic focal epilepsy with complex partial seizures that is drug-resistant but without current status epilepticus. These patients have ongoing seizures with impaired consciousness despite adequate medication trials. They often require evaluation for epilepsy surgery, vagus nerve stimulation, or other advanced interventions to achieve seizure control.
Documentation Requirements
- ✓Documentation of symptomatic focal epilepsy with identified underlying cause
- ✓Complex partial seizure type (impaired consciousness) documented
- ✓Evidence of intractability: at least 2 failed adequate antiepileptic medication trials
- ✓Ongoing seizure frequency documentation despite treatment compliance
- ✓Underlying structural or metabolic cause identified and coded separately
- ✓Evaluation for advanced treatment options (surgery, neurostimulation) if applicable
Commonly Confused Codes
G40.209 — Same type, NOT intractable; medication responsiveG40.211 — Same type, intractable, WITH status epilepticus; acute emergencyG40.119 — Symptomatic focal with SIMPLE partial seizures, intractable; consciousness preservedG40.319 — Generalized idiopathic epilepsy, intractable; generalized onsetG40.919 — Epilepsy unspecified, intractable; less specific
Code Hierarchy
└G40Epilepsy and recurrent seizures└G40.2Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures└G40.21Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable└G40.219Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus
└G40.219Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus