ICD-10 G40.411
Billable / Specific HCC v28: 79 CCOther generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
About ICD-10-CM G40.411
ICD-10-CM code G40.411 represents Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus. This is a billable/specific code in the Nervous System chapter (block G40). The 2026 edition of ICD-10-CM G40.411 became effective on October 1, 2025.
Coding Tips for G40.411
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G40.411 is a CMS-HCC v28 risk-adjustment code (category 79). 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.
G40.411 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.
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 Other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G40.411
Local Coverage Determinations (LCDs) from CMS MACs that list G40.411 as a covered diagnosis.
Showing top 10 of 617 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G40.411.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with G40.411
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G0252 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- 78608 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9597 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9601 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0235 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- 78609 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9552 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0219 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9598 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0480 CMS LCD: Billing and Coding: Urine Drug Testing CMS LCD
Convert G40.411 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 |
|---|---|---|
| G40.411 | 34511 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G40.411
Other codes in section G40-G47 (Episodic and paroxysmal disorders).
ICD-10 G40.411, Billing FAQ
Is ICD-10 code G40.411 billable? +
Yes, G40.411 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does G40.411 affect Medicare Advantage HCC risk adjustment? +
Yes. G40.411 maps to CMS-HCC v28 category 79. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G40.411 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 G40.411? +
Procedures frequently paired with G40.411 include: G0252, 78608, A9597, A9601, G0235.
What ICD-9 codes does G40.411 map to? +
Per CMS GEMs, G40.411 maps to ICD-9 codes: 34511. 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 June 1, 2026.
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