ICD-10 G70.81
Billable / Specific HCC v28: 75 CCLambert-Eaton syndrome in disease classified elsewhere
About ICD-10-CM G70.81
ICD-10-CM code G70.81 represents Lambert-Eaton syndrome in disease classified elsewhere. This is a billable/specific code in the Nervous System chapter (block G70). The 2026 edition of ICD-10-CM G70.81 became effective on October 1, 2025.
Coding Tips for G70.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G70.81 is a CMS-HCC v28 risk-adjustment code (category 75). 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.
G70.81 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with G70.81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- Lambert-Eaton syndrome in neoplastic disease (G73.1)
Coding Notes
Code First
- underlying 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 Lambert-Eaton syndrome in disease classified elsewhere. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G70.81
Local Coverage Determinations (LCDs) from CMS MACs that list G70.81 as a covered diagnosis.
Showing top 10 of 962 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G70.81.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with G70.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert G70.81 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 |
|---|---|---|
| G70.81 | 35839 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G70.81
Other codes in section G70-G73 (Diseases of myoneural junction and muscle).
ICD-10 G70.81, Billing FAQ
Is ICD-10 code G70.81 billable? +
Yes, G70.81 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for G70.81? +
Type 1 Excludes (never code together with G70.81): Lambert-Eaton syndrome in neoplastic disease (G73.1)
Does G70.81 affect Medicare Advantage HCC risk adjustment? +
Yes. G70.81 maps to CMS-HCC v28 category 75. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G70.81 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 G70.81? +
Procedures frequently paired with G70.81 include: G0161, G0153.
What ICD-9 codes does G70.81 map to? +
Per CMS GEMs, G70.81 maps to ICD-9 codes: 35839. 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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