G40.411

HCC Category Mapping

What This Code Means

This code describes a severe form of epilepsy where seizures occur throughout the brain and cannot be controlled with medication, and the patient is currently experiencing status epilepticus (a prolonged or repeated seizure emergency). This is a serious neurological condition requiring immediate medical intervention.

Coding Tips

• •Verify documentation confirms both intractability (drug-resistant) and active status epilepticus before assigning this code, as status epilepticus is a time-specific acute condition
• •Status epilepticus is a medical emergency; ensure this code is used only when the patient is actively experiencing prolonged or recurrent seizures without full recovery between episodes

Clinical Significance

Intractable other generalized epilepsy with status epilepticus represents the most severe presentation in this code family — drug-resistant seizures involving both hemispheres with a life-threatening prolonged seizure emergency. These patients require intensive medical management, often ICU-level care, and may be candidates for surgical intervention or neurostimulation devices. This combination indicates exceptionally high resource utilization.

Documentation Requirements

• ✓Explicit documentation of intractable or drug-resistant epilepsy (pharmacoresistant)
• ✓Evidence of failed trials of at least two appropriately chosen antiepileptic drugs
• ✓Documentation of active status epilepticus during the encounter
• ✓Emergency interventions and treatments administered
• ✓Specific type of generalized epilepsy and underlying etiology if known
• ✓Current and prior medication history demonstrating intractability

Commonly Confused Codes