ICD-10 G83.4
Billable / Specific HCC v28: 72 CCCauda equina syndrome
About ICD-10-CM G83.4
ICD-10-CM code G83.4 represents Cauda equina syndrome. This is a billable/specific code in the Nervous System chapter (block G83). The 2026 edition of ICD-10-CM G83.4 became effective on October 1, 2025.
Coding Tips for G83.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G83.4 is a CMS-HCC v28 risk-adjustment code (category 72). 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.
G83.4 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 G83.4. Per CMS ICD-10-CM Tabular 2026.
- Neurogenic bladder due to cauda equina syndrome
Type 1 Excludes
Pure excludes, these codes can never be coded together with G83.4. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- cord bladder NOS (G95.89)
- neurogenic bladder NOS (N31.9)
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 Cauda equina syndrome. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G83.4
Local Coverage Determinations (LCDs) from CMS MACs that list G83.4 as a covered diagnosis.
Showing top 10 of 587 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G83.4.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with G83.4
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 91125 CMS LCD: Billing and Coding: Pelvic Floor Dysfunction: Anorectal Manometry and EMG CMS LCD
Convert G83.4 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 |
|---|---|---|
| G83.4 | 34460 | 10000 |
| G83.4 | 34461 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G83.4
Other codes in section G80-G83 (Cerebral palsy and other paralytic syndromes).
ICD-10 G83.4, Billing FAQ
Is ICD-10 code G83.4 billable? +
Yes, G83.4 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 G83.4? +
ICD-10 G83.4 includes: Neurogenic bladder due to cauda equina syndrome.
What codes are Type 1 Excludes for G83.4? +
Type 1 Excludes (never code together with G83.4): cord bladder NOS (G95.89); neurogenic bladder NOS (N31.9)
Does G83.4 affect Medicare Advantage HCC risk adjustment? +
Yes. G83.4 maps to CMS-HCC v28 category 72. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is G83.4 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 G83.4? +
Procedures frequently paired with G83.4 include: 91125.
What ICD-9 codes does G83.4 map to? +
Per CMS GEMs, G83.4 maps to ICD-9 codes: 34460, 34461. 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 June 1, 2026.
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