AHA Coding Clinic® for ICD-9 - 2011 Issue 2; Ask the Editor
Conversion Disorder with Pseudoseizures
A 13-year-old male, who had a history of absence seizures until age 7, was admitted with seizure-like episodes occurring over the past 2 months. The patient had a history of posttraumatic stress disorder, and attention deficit hyperactivity disorder. He was experiencing several emotional stressors that appeared to make the seizure-like episodes worse. While hospitalized he had a full neurological workup, which was negative for seizure disorder. He underwent psychiatric evaluation and was diagnosed with conversion disorder with pseudoseizures. The patient was discharged with instructions to follow-up with outpatient psychiatric counseling. The provider listed the following discharge diagnoses: conversion disorder with pseudoseizure; post-traumatic stress disorder; conduct disorder; attention deficit hyperactivity disorder; and generalized anxiety disorder. Should code 300.11, Conversion disorder, or code 780.39, Other convulsions, be assigned as the principal diagnosis since the pseudoseizures were the reason for admission and this was a medical admission and not psychiatric? ...
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Article Overview
This article reviews a pediatric case involving seizure-like episodes, negative neurological evaluation, and psychiatric assessment leading to a conversion disorder diagnosis with pseudoseizures. It is relevant to coders, CDI specialists, and clinicians who need to understand how the case context, discharge diagnoses, and diagnosis coding considerations are presented in a mental health and neurology-related setting.
Why This Topic Matters
Cases like this often raise questions about how to represent complex symptom presentations after workup and specialty evaluation. The article helps readers understand the coding context for a psychiatric diagnosis in a scenario where the initial presentation resembles a neurologic condition.
What You Will Learn
- How a seizure-like presentation may be discussed in relation to psychiatric evaluation
- What kinds of discharge diagnoses are listed in a case involving conversion disorder
- How coding questions can arise when symptoms and confirmed diagnoses do not match the initial clinical impression
- How the article frames the role of follow-up psychiatric counseling in the case context
Who Should Read This
- Medical coders
- Coding auditors
- CDI specialists
- Mental health providers
- Neurology providers
Codes Discussed
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