Is ICD-10-CM code R56 billable?

No, R56 (Convulsions, not elsewhere classified) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code R56 belong to?

R56 belongs to Chapter 18 of the ICD-10-CM tabular list: R00–R99 (Symptoms, Signs and Abnormal Clinical and Laboratory Findings).

R56Not billable, use a more specific code below

Convulsions, not elsewhere classified

In General symptoms and signs (R50-R69), chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings

4 billable codes under R56: 3 are a CC; all map to HCC 201 (Seizure Disorders and Convulsions).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

dissociative convulsions and seizures (F44.5)
epileptic convulsions and seizures (G40.-)
newborn convulsions and seizures (P90)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers when to report symptom, sign, and abnormal finding codes (R00-R99), plus specific rules for falls, coma scales, non-infectious SIRS, death NOS, and NIHSS scores.

Use of symptom codes (page 75)
Use of a symptom code with a definitive diagnosis code (page 75)
Combination codes that include symptoms (page 75)
Repeated falls (page 76)
Coma (page 76)
Functional quadriplegia (page 76)
SIRS due to Non-Infectious Process (page 77)
Death NOS (page 77)

Read Section I.C.18 (page 75), 1 more topics

All codes under R56

R56 can't be used on a claim. Pick a billable code below; grey headings group them.

R56 MS-DRGs

As the principal diagnosis, the billable codes under R56 group to MS-DRG 100, 101, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 100 Seizures with MCC (4 of 4 codes)
DRG 101 Seizures without MCC (4 of 4 codes)
DRG 791 Prematurity with Major Problems (2 of 4 codes)
DRG 793 Full Term Neonate with Major Problems (2 of 4 codes)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Seizures

Seizures are symptoms of a brain problem. They happen because of sudden, abnormal electrical activity in the brain. When people think of seizures, they often think of convulsions in which a person's body shakes rapidly and uncontrollably. Not all seizures cause convulsions. There are many types of seizures and some have mild symptoms. Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides of the brain.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.