ICD-10 R56.00
Billable / Specific HCC v28: 79 CCSimple febrile convulsions
About ICD-10-CM R56.00
ICD-10-CM code R56.00 represents Simple febrile convulsions. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R56). The 2026 edition of ICD-10-CM R56.00 became effective on October 1, 2025.
Coding Tips for R56.00
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R56.00 is a CMS-HCC v28 risk-adjustment code (category 79). 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.
R56.00 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 R56.00. Per CMS ICD-10-CM Tabular 2026.
- Febrile convulsion NOS
- Febrile seizure NOS
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 Simple febrile convulsions. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for R56.00
Local Coverage Determinations (LCDs) from CMS MACs that list R56.00 as a covered diagnosis.
Showing top 10 of 100 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R56.00.
1 Aetna
5 Medicare
CPT Codes Commonly Billed with R56.00
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 R56.00 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 |
|---|---|---|
| R56.00 | 78031 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R56.00
Other codes in section R50-R69 (General symptoms and signs).
ICD-10 R56.00, Billing FAQ
Is ICD-10 code R56.00 billable? +
Yes, R56.00 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 R56.00? +
ICD-10 R56.00 includes: Febrile convulsion NOS; Febrile seizure NOS.
Does R56.00 affect Medicare Advantage HCC risk adjustment? +
Yes. R56.00 maps to CMS-HCC v28 category 79. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is R56.00 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 R56.00 map to? +
Per CMS GEMs, R56.00 maps to ICD-9 codes: 78031. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team