ICD-10 Code for Non-Epileptic Seizures
The ICD-10 code for psychogenic non-epileptic seizures (PNES) is F44.5 (conversion disorder or functional neurological disorder with seizures or convulsions), which has been validated as the most accurate code with a positive predictive value of 74-80% for identifying these patients. 1
Primary Coding
- F44.5 is the preferred ICD-10 code for psychogenic non-epileptic seizures, demonstrating superior diagnostic accuracy compared to alternative codes 1
- This code achieved a sensitivity of 67.1%, specificity of 95.8%, and positive predictive value of 91.7% in epilepsy monitoring unit settings 1
- F44.5 classifies PNES as conversion disorder/functional neurological disorder with seizures or convulsions 1
Alternative Historical Code (ICD-9-CM)
- The older ICD-9-CM code 300.11 (conversion disorder) was previously used but performed significantly worse, with only 52% positive predictive value for presumptive PNES 1
- When probable/possible PNES cases were included, code 300.11 achieved only 59% positive predictive value 1
Codes to Avoid
- R56.9 (unspecified convulsions) has a positive predictive value of 20% or less and should not be used for PNES 1
- 780.39 (other convulsions - ICD-9-CM) similarly performed poorly with PPV ≤20% 1
Classification Context
- ICD-10 classifies PNES within dissociative disorders, merging dissociative and conversion disorders 2, 3
- DSM-5 categorizes PNES as a subgroup of conversion disorders, representing a different classification approach 4, 3
- PNES affect 20-30% of patients attending epilepsy centers and represent a significant diagnostic challenge 5
Clinical Caveat
- Even with F44.5's superior performance, approximately 20-26% of coded patients may not have presumptive PNES, highlighting the importance of video-EEG confirmation when diagnostic certainty is required 1