Find information on psychogenic nonepileptic seizures PNES diagnosis, including clinical documentation, medical coding, and healthcare resources. Learn about differentiating PNES from epileptic seizures, PNES ICD-10 code (F44.5), DSM-5 criteria, and effective treatment options for patients experiencing PNES episodes. Explore resources for healthcare professionals, including diagnostic criteria, treatment guidelines, and best practices for documenting PNES in medical records. This resource provides essential information for accurate PNES diagnosis, coding, and management.
Also known as
Conversion disorder with seizures
Psychogenic nonepileptic seizures, a conversion disorder.
Dissociative and conversion disorders
Mental disorders involving disruptions in consciousness, memory, identity.
Neurotic, stress-related disorders
Mental disorders caused by stress, including anxiety and somatoform.
Follow this step-by-step guide to choose the correct ICD-10 code.
Confirmed diagnosis of Psychogenic Nonepileptic Seizures?
Yes
Documented physiological stressor?
No
Do NOT code as Psychogenic Nonepileptic Seizure. Evaluate for other diagnoses.
When to use each related code
| Description |
|---|
| Sudden, altered behavior mimicking epileptic seizures, but without EEG changes. |
| Recurrent epileptic seizures due to abnormal brain activity. |
| Transient LOC due to reduced cerebral blood flow. |
Coding F44.5 without sufficient documentation specifying the nature of the nonepileptic seizures risks inaccurate reimbursement and data reporting.
Misdiagnosis or incorrect coding when comorbid conditions like anxiety or depression (F41.x, F32.x) are present, impacting quality metrics.
Lack of clear documentation confirming epilepsy ruled out (G40.x) before assigning PNES code creates compliance and medical necessity issues.
Q: How can I differentiate between psychogenic nonepileptic seizures (PNES) and epileptic seizures in a patient presenting with seizure-like events?
A: Differentiating between psychogenic nonepileptic seizures (PNES) and epileptic seizures requires a thorough clinical evaluation incorporating several key factors. While video-EEG monitoring remains the gold standard for diagnosis, consider these distinguishing features: PNES often exhibit asynchronous movements, fluctuating course during the event, eye closure during the event, and lack of post-ictal confusion. Epileptic seizures typically present with stereotyped movements, a defined ictal period, and a post-ictal phase. Examine for the presence of tongue biting, urinary incontinence, and injuries sustained during the event, which are more suggestive of epileptic seizures. Explore how incorporating detailed patient history, including psychological factors like trauma or stress, can aid in accurate PNES diagnosis. Consider implementing a multidisciplinary approach involving neurology, psychiatry, and psychology for optimal patient management.
Q: What are the evidence-based best practices for managing and treating patients with a confirmed diagnosis of psychogenic nonepileptic seizures (PNES)?
A: Evidence-based PNES management begins with clear communication of the diagnosis to the patient, emphasizing the real and treatable nature of the condition. Cognitive Behavioral Therapy (CBT) has emerged as a first-line treatment modality, demonstrating efficacy in reducing seizure frequency and improving psychological well-being. Other psychotherapeutic interventions, such as psychodynamic therapy and mindfulness-based techniques, may also be beneficial. While pharmacotherapy plays a limited role in directly treating PNES, it can be used to manage comorbid psychiatric conditions like anxiety or depression. Consider implementing collaborative care models involving neurologists, psychiatrists, psychologists, and other healthcare professionals. Learn more about the crucial role of patient education in dispelling misconceptions and promoting treatment adherence.
Patient presents with episodes concerning for seizures. Symptoms include convulsions, shaking, unresponsiveness, and altered mental status. However, diagnostic workup including EEG monitoring was negative for epileptiform activity, indicating psychogenic nonepileptic seizures (PNES) as the probable diagnosis. Differential diagnosis included epilepsy, syncope, conversion disorder, and factitious disorder. The patient's history reveals significant psychosocial stressors including recent job loss and interpersonal conflict. The patient denies any conscious production of symptoms. Clinical findings support a diagnosis of PNES based on the absence of electrographic seizure activity during a witnessed event and the presence of prominent emotional stressors. The patient was educated about the diagnosis of PNES, emphasizing that it is a real condition with a psychological basis. Treatment recommendations include referral to mental health services for psychotherapy, specifically cognitive behavioral therapy (CBT) or trauma-informed therapy if indicated. Prognosis for PNES is variable, and patient compliance with therapy is essential. ICD-10 code F44.5 (Conversion disorder with seizures or convulsions) is documented for billing purposes. Continued monitoring and follow-up care are planned to assess treatment response and provide ongoing support. Patient understanding of the diagnosis and treatment plan was confirmed.