The question asked: When is code 780.39 used anymore? I was told to use 345.90 even if epilepsy wasn't documented.
Answer: So much depends on the MD's documentation for the seizure. As of 10/1/06 the index changed so that now a "seizure disorder" is classified with the epilepsy codes. We have to follow the updated index and use it based on the documentation we have. Indexing: "Disorder / seizure", and "Seizure / recurrent" now go to 345.90, while indexing "Seizure / repetitive" goes to 780.39. Here is what I found out at a Neurology Inservice that I recently attended. The index changes were discussed. The national association of neurologists are in the process of changing the definition of epilepsy. The new definition will be more than one seizure (without any known cause, like a sudden head injury, high fever, or severe metabolic problem) occuring over a period of time (such as months or years.) That's why ICD-9 has classified a seizure disorder or recurrent seizures to 345.90. And it's probably why "repetitive" still codes to 780.39, since the repetitive seizures might actually all be a part of one episode of seizures (given that they probably aren't separated by months or years.)
So make your code assignment of either 780.39 or 345.90 based on what the MD has stated, but if that isn't clear -- then query. Coding Clinic has not addressed the 10/1/06 index changes, but we still have to follow the index as any index change would supercede the older CC92Q4 advice.