ICD-10 G71.09
Billable / Specific HCC v28: 76Other specified muscular dystrophies
About ICD-10-CM G71.09
ICD-10-CM code G71.09 represents Other specified muscular dystrophies. This is a billable/specific code in the Nervous System chapter (block G71). The 2026 edition of ICD-10-CM G71.09 became effective on October 1, 2025.
Coding Tips for G71.09
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G71.09 is a CMS-HCC v28 risk-adjustment code (category 76). 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under G71.09. Per CMS ICD-10-CM Tabular 2026.
- Benign scapuloperoneal muscular dystrophy with early contractures [Emery-Dreifuss]
- Congenital muscular dystrophy NOS
- Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber
- Distal muscular dystrophy
- Ocular muscular dystrophy
- Oculopharyngeal muscular dystrophy
- Scapuloperoneal muscular dystrophy
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.
Medicare LCD Coverage for G71.09
Local Coverage Determinations (LCDs) from CMS MACs that list G71.09 as a covered diagnosis.
Showing top 10 of 622 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G71.09.
1 Aetna
4 Cigna
5 Medicare
CPT Codes Commonly Billed with G71.09
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To G71.09
Other codes in section G70-G73 (Diseases of myoneural junction and muscle).
ICD-10 G71.09, Billing FAQ
Is ICD-10 code G71.09 billable? +
Yes, G71.09 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 G71.09? +
ICD-10 G71.09 includes: Benign scapuloperoneal muscular dystrophy with early contractures [Emery-Dreifuss]; Congenital muscular dystrophy NOS; Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber, and 4 more clinical synonyms.
Does G71.09 affect Medicare Advantage HCC risk adjustment? +
Yes. G71.09 maps to CMS-HCC v28 category 76. Capture this diagnosis annually for accurate Medicare Advantage risk score.
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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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