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Epileptic Seizure F050
Current RMA Instruments:
|Reasonable Hypothesis SOP||77 of 2013|
|Balance of Probabilities SOP||78 of 2013|
Changes from Previous Instruments:
- ICD-9-CM Codes: 780.3
- ICD-10-AM Codes: R56.8
This is a single neurological event which is associated with several different types of acute brain pathology which caused a temporary electrical dysfunction. Where there are multiple seizures which chronically recur, the SOP for epilepsy applies. Note that the single neurological event can persist for 24 hours causing multiple seizures, but subsequently once the temporary acute brain pathology is resolved, there is no enduring propensity to manifest with seizures. See further information, below.
Is specific diagnostic evidence required to apply the SOP? – No.
Diagnosis is normally based on specialist opinion and imaging of the brain is usually undertaken. The appropriate medical specialist is a neurologist.
Are there sub-factors that require specific information? – No.
Additional diagnoses which may be covered by SOP
- epileptic fit
Conditions excluded from SOP
- epilepsy, ICD codes 333.2, 345.0-345.5, 345.7-345.9
- febrile seizures.
- infantile seizure; neonatal seizures.
- movement disorders associated with sleep including restless legs syndrome and periodic limb movement disorder, cataplexy.
- reflex epilepsy, ICD code 345.1
- seizures due to syncope/ faint; G-forced induced loss of consciousness; migraine; vertigo
- hysterical or psychogenic seizure, ICD code 300.11
If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.
There is a separate SOP for epilepsy. The epileptic seizure SOP applies if:
- There has only ever been one seizure event #
- There has been an acute precipitating cause for a seizure, e.g. a low blood sugar level, a high blood calcium level or acute brain hypoxia (decreased oxygen supply) at the time of the seizure.
If there have been two or more seizures, more than 24 hours apart and not due to an acute precipitating cause, then the epilepsy SOP applies.
Both SOPs may apply in the one case:
- If a claimant has epilepsy (and that SOP applies or has been applied previously), but there is a new seizure event, due to an acute precipitating cause, then the epileptic seizure SOP will also apply.
- Two seizure events, not due to an acute precipitating cause, are required to apply the epilepsy SOP (and to make the diagnosis). If there has been only one such seizure, the epileptic seizure SOP applies, if there is subsequently a second such seizure, the diagnosis of epilepsy can then be made and the epilepsy SOP would then apply. There may be months, years or even decades between such seizures.
# Multiple seizures within a 24 hour period = 1 event