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?
Assign code 300.11, Conversion disorder, as the principal diagnosis, since that was the condition established after study to be chiefly responsible for the admission. Code 780.39, Other convulsions, should also be assigned to provide further detail about the patient's condition, since convulsions are not routinely associated with a conversion disorder. A conversion disorder can manifest in many different ways. Assign codes 314.01, Attention deficit disorder, with hyperactivity; 309.81, Posttraumatic stress disorder; 312.9, Unspecified disturbance of conduct; and 300.00, Anxiety state, unspecified, as additional diagnoses.