R56.1: Post traumatic seizures
R56.1 is a billable, specific ICD-10-CM code for post traumatic seizures. It is valid for submission on a claim.
Check R56.1 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- post traumatic epilepsy (G40.-)
Other codes that can never be billed with R56.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
R56.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 201 Seizure Disorders and Convulsions0.245 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
R56.1 is named in 12 Medicare coverage policies: 12 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56612Billing and Coding: CT of the Head
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
- A56756Billing and Coding: Home Health - Psychiatric Care
- A56771Billing and Coding: Special Electroencephalography
Alphabetic index entries that lead here
- Convulsions›post traumatic
- Seizure›post traumatic
Code history
Unchanged in every release from FY2024 to FY2027.