ICD-10 G11.3
Billable / Specific HCC v28: 72 CCCerebellar ataxia with defective DNA repair
About ICD-10-CM G11.3
ICD-10-CM code G11.3 represents Cerebellar ataxia with defective DNA repair. This is a billable/specific code in the Nervous System chapter (block G11). The 2026 edition of ICD-10-CM G11.3 became effective on October 1, 2025.
Coding Tips for G11.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G11.3 is a CMS-HCC v28 risk-adjustment code (category 72). 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.
G11.3 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 G11.3. Per CMS ICD-10-CM Tabular 2026.
- Ataxia telangiectasia [Louis-Bar]
Type 2 Excludes
Not included here, the excluded code is not part of G11.3, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- Cockayne's syndrome (Q87.19)
- other disorders of purine and pyrimidine metabolism (E79.-)
- xeroderma pigmentosum (Q82.1)
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 Cerebellar ataxia with defective DNA repair. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G11.3
Local Coverage Determinations (LCDs) from CMS MACs that list G11.3 as a covered diagnosis.
Showing top 10 of 549 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G11.3.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with G11.3
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95926 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95925 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95938 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95927 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 29405 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 95992 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29280 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97010 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 29515 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
- 97550 CMS LCD: Billing and Coding: Outpatient Physical Therapy CMS LCD
Convert G11.3 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 |
|---|---|---|
| G11.3 | 3348 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G11.3
Other codes in section G10-G14 (Systemic atrophies primarily affecting the central nervous system).
ICD-10 G11.3, Billing FAQ
Is ICD-10 code G11.3 billable? +
Yes, G11.3 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 G11.3? +
ICD-10 G11.3 includes: Ataxia telangiectasia [Louis-Bar].
What codes are Type 2 Excludes for G11.3? +
Type 2 Excludes (may be coded together when both conditions exist): Cockayne's syndrome (Q87.19); other disorders of purine and pyrimidine metabolism (E79.-); xeroderma pigmentosum (Q82.1)
Does G11.3 affect Medicare Advantage HCC risk adjustment? +
Yes. G11.3 maps to CMS-HCC v28 category 72. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G11.3 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 G11.3? +
Procedures frequently paired with G11.3 include: 95926, 95925, 95938, 95927, 29405.
What ICD-9 codes does G11.3 map to? +
Per CMS GEMs, G11.3 maps to ICD-9 codes: 3348. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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