ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 G93.49

Billable / Specific CC

Other encephalopathy

G93
Block
1
Synonyms
174
LCDs
19
Payer Policies
0
Linked CPTs

About ICD-10-CM G93.49

ICD-10-CM code G93.49 represents Other encephalopathy. This is a billable/specific code in the Nervous System chapter (block G93). The 2026 edition of ICD-10-CM G93.49 became effective on October 1, 2025.

Coding Tips for G93.49

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: CC

G93.49 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 G93.49. Per CMS ICD-10-CM Tabular 2026.

  • Encephalopathy NEC

Inpatient DRG Impact, CC

codes Other encephalopathy. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.

Medicare LCD Coverage for G93.49

Local Coverage Determinations (LCDs) from CMS MACs that list G93.49 as a covered diagnosis.

174 LCDs

Showing top 10 of 174 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1459 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1573 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1552 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1566 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1557 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J0840 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1571 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT 90376 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1560 →
CMS LCD: Billing and Coding: Immune Globulins
Article ID: 57554, Effective: 2026-04-09 00:00:00, 1176 covered, 0 non-covered
CPT J1572 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing G93.49.

19 policies

2 Cigna

Flow Cytometry - (0538)
Policy ID: MM_0538
Neuropsychological Testing - (EN0258)
Policy ID: EN_MM_0258

5 Medicare

Billing and Coding: Visual Fields Testing
Policy ID: ART-56551
Billing and Coding: CT of the Head
Policy ID: ART-56612
Billing and Coding: Heavy Metal Testing
Policy ID: ART-56767
Billing and Coding: Immune Globulin
Policy ID: ART-56786
Billing and Coding: Visual Fields Testing
Policy ID: ART-56799

4 Aetna

Parenteral Immunoglobulins
Policy ID: CPB-0206
Cognitive Rehabilitation
Policy ID: CPB-0214
Quantitative EEG (Brain Mapping)
Policy ID: CPB-0221
Rituximab
Policy ID: CPB-0314

CPT Codes Commonly Billed with G93.49

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for G93.49

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 G93.49 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
G93.49 34839 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 G93.49, Billing FAQ

Is ICD-10 code G93.49 billable? +

Yes, G93.49 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 G93.49? +

ICD-10 G93.49 includes: Encephalopathy NEC.

Is G93.49 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 G93.49 map to? +

Per CMS GEMs, G93.49 maps to ICD-9 codes: 34839. 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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