G40.401
BillableOther generalized epilepsy and epileptic syndromes, not intractable, with 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 164 — Seizure Disorders, Non-Intractable Epilepsy
0.000What This Code Means
A generalized epilepsy of a type other than idiopathic that is controllable with medication, but the patient is currently experiencing status epilepticus.
Coding Tips
- •The '4' in the fourth character indicates 'other' generalized epilepsy, which may have a secondary cause that should be documented
- •Identify and document the underlying cause (e.g., brain injury, infection, tumor) if known
Clinical Significance
Other generalized epilepsy with status epilepticus represents a neurological emergency where seizures involve both brain hemispheres and persist beyond 5 minutes or recur without recovery. This diagnosis drives significant resource utilization for emergency management including IV benzodiazepines, continuous EEG monitoring, and potential ICU admission. Accurate capture is critical for risk adjustment as it reflects a patient with higher-than-average healthcare needs.
Documentation Requirements
- ✓Specific type of generalized epilepsy documented (e.g., secondary to brain injury, infection, or tumor)
- ✓Statement confirming seizures are NOT intractable/drug-resistant (responsive to medication)
- ✓Documentation of active status epilepticus during the encounter (seizure duration >5 minutes or recurrent seizures without recovery)
- ✓Current antiepileptic drug regimen with dosages
- ✓Emergency interventions provided for status epilepticus
- ✓Underlying etiology if known (structural, metabolic, genetic)
Commonly Confused Codes
G40.409 — Same epilepsy type, not intractable, but WITHOUT status epilepticus; use when patient is not in prolonged seizure stateG40.411 — Same epilepsy type WITH status epilepticus but INTRACTABLE (drug-resistant); requires documentation of failed medication trialsG40.301 — Generalized IDIOPATHIC epilepsy with status epilepticus; use when epilepsy has no identified secondary causeG40.901 — Epilepsy UNSPECIFIED with status epilepticus; use only when epilepsy type cannot be determinedG40.801 — Other epilepsy (not fitting specific syndromes) with status epilepticus; less specific than G40.4 series
Code Hierarchy
└G40Epilepsy and recurrent seizures└G40.4Other generalized epilepsy and epileptic syndromes└G40.40Other generalized epilepsy and epileptic syndromes, not intractable└G40.401Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus
└G40.401Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus