ICD-10 E75.4
Billable / Specific HCC v28: 52 CCNeuronal ceroid lipofuscinosis
About ICD-10-CM E75.4
ICD-10-CM code E75.4 represents Neuronal ceroid lipofuscinosis. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E75). The 2026 edition of ICD-10-CM E75.4 became effective on October 1, 2025.
Coding Tips for E75.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E75.4 is a CMS-HCC v28 risk-adjustment code (category 52). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
E75.4 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under E75.4. Per CMS ICD-10-CM Tabular 2026.
- Batten disease
- Bielschowsky-Jansky disease
- Kufs disease
- Spielmeyer-Vogt disease
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Neuronal ceroid lipofuscinosis. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for E75.4
Local Coverage Determinations (LCDs) from CMS MACs that list E75.4 as a covered diagnosis.
Showing top 10 of 92 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E75.4.
3 Medicare
1 Aetna
1 NY Medicaid
CPT Codes Commonly Billed with E75.4
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95857 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92512 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92617 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92520 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92630 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92612 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92606 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92618 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 92650 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
- 31579 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
Convert E75.4 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E75.4 | 3301 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E75.4
Other codes in section E70-E88 (Metabolic disorders).
ICD-10 E75.4, Billing FAQ
Is ICD-10 code E75.4 billable? +
Yes, E75.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to E75.4? +
ICD-10 E75.4 includes: Batten disease; Bielschowsky-Jansky disease; Kufs disease, and 1 more clinical synonyms.
Does E75.4 affect Medicare Advantage HCC risk adjustment? +
Yes. E75.4 maps to CMS-HCC v28 category 52. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is E75.4 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with E75.4? +
Procedures frequently paired with E75.4 include: 95857, 92512, 92617, 92520, 92630.
What ICD-9 codes does E75.4 map to? +
Per CMS GEMs, E75.4 maps to ICD-9 codes: 3301. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team