ICD-10 G71.20
Billable / Specific HCC v28: 76 CCCongenital myopathy, unspecified
About ICD-10-CM G71.20
ICD-10-CM code G71.20 represents Congenital myopathy, unspecified. This is a billable/specific code in the Nervous System chapter (block G71). The 2026 edition of ICD-10-CM G71.20 became effective on October 1, 2025.
Coding Tips for G71.20
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G71.20 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.
G71.20 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 Congenital myopathy, unspecified. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G71.20
Local Coverage Determinations (LCDs) from CMS MACs that list G71.20 as a covered diagnosis.
Showing top 10 of 529 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G71.20.
3 Aetna
3 Cigna
5 Medicare
CPT Codes Commonly Billed with G71.20
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Codes Adjacent To G71.20
Other codes in section G70-G73 (Diseases of myoneural junction and muscle).
ICD-10 G71.20, Billing FAQ
Is ICD-10 code G71.20 billable? +
Yes, G71.20 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does G71.20 affect Medicare Advantage HCC risk adjustment? +
Yes. G71.20 maps to CMS-HCC v28 category 76. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G71.20 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 G71.20? +
Procedures frequently paired with G71.20 include: G0161, G0153.
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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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