ICD-10 G72.81
Billable / Specific CCCritical illness myopathy
About ICD-10-CM G72.81
ICD-10-CM code G72.81 represents Critical illness myopathy. This is a billable/specific code in the Nervous System chapter (block G72). The 2026 edition of ICD-10-CM G72.81 became effective on October 1, 2025.
Coding Tips for G72.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G72.81 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under G72.81. Per CMS ICD-10-CM Tabular 2026.
- Acute necrotizing myopathy
- Acute quadriplegic myopathy
- Intensive care (ICU) myopathy
- Myopathy of critical illness
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 Critical illness myopathy. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G72.81
Local Coverage Determinations (LCDs) from CMS MACs that list G72.81 as a covered diagnosis.
Showing top 10 of 432 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G72.81.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with G72.81
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.
Convert G72.81 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 |
|---|---|---|
| G72.81 | 35981 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G72.81
Other codes in section G70-G73 (Diseases of myoneural junction and muscle).
ICD-10 G72.81, Billing FAQ
Is ICD-10 code G72.81 billable? +
Yes, G72.81 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 G72.81? +
ICD-10 G72.81 includes: Acute necrotizing myopathy; Acute quadriplegic myopathy; Intensive care (ICU) myopathy, and 1 more clinical synonyms.
Is G72.81 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 ICD-9 codes does G72.81 map to? +
Per CMS GEMs, G72.81 maps to ICD-9 codes: 35981. 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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