ICD-10 G71.11
Billable / Specific HCC v28: 76Myotonic muscular dystrophy
About ICD-10-CM G71.11
ICD-10-CM code G71.11 represents Myotonic muscular dystrophy. This is a billable/specific code in the Nervous System chapter (block G71). The 2026 edition of ICD-10-CM G71.11 became effective on October 1, 2025.
Coding Tips for G71.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G71.11 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 G71.11. Per CMS ICD-10-CM Tabular 2026.
- Dystrophia myotonica [Steinert]
- Myotonia atrophica
- Myotonic dystrophy
- Proximal myotonic myopathy (PROMM)
- Steinert 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.
Medicare LCD Coverage for G71.11
Local Coverage Determinations (LCDs) from CMS MACs that list G71.11 as a covered diagnosis.
Showing top 10 of 734 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G71.11.
1 Aetna
4 Cigna
5 Medicare
CPT Codes Commonly Billed with G71.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert G71.11 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 |
|---|---|---|
| G71.11 | 35921 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G71.11
Other codes in section G70-G73 (Diseases of myoneural junction and muscle).
ICD-10 G71.11, Billing FAQ
Is ICD-10 code G71.11 billable? +
Yes, G71.11 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 G71.11? +
ICD-10 G71.11 includes: Dystrophia myotonica [Steinert]; Myotonia atrophica; Myotonic dystrophy, and 2 more clinical synonyms.
Does G71.11 affect Medicare Advantage HCC risk adjustment? +
Yes. G71.11 maps to CMS-HCC v28 category 76. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with G71.11? +
Procedures frequently paired with G71.11 include: G0161, G0153.
What ICD-9 codes does G71.11 map to? +
Per CMS GEMs, G71.11 maps to ICD-9 codes: 35921. 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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