G40.401 ICD-10-CM Code: Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus

Code

G40.401

Description

Other generalized epilepsy and epileptic syndromes, not intractable, with status epilepticus

HCC (V28)

HCC 201 — Seizure Disorders and Convulsions

RAF reference coefficient

0.245

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work G40.401 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for G40.401

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for G40.401 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

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 state
• •G40.411: Same epilepsy type WITH status epilepticus but INTRACTABLE (drug-resistant); requires documentation of failed medication trials
• •G40.301: Generalized IDIOPATHIC epilepsy with status epilepticus; use when epilepsy has no identified secondary cause
• •G40.901: Epilepsy UNSPECIFIED with status epilepticus; use only when epilepsy type cannot be determined
• •G40.801: Other epilepsy (not fitting specific syndromes) with status epilepticus; less specific than G40.4 series

Child Codes