ICD-10 R56.9
Billable / Specific HCC v28: 79Unspecified convulsions
About ICD-10-CM R56.9
ICD-10-CM code R56.9 represents Unspecified convulsions. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R56). The 2026 edition of ICD-10-CM R56.9 became effective on October 1, 2025.
Coding Tips for R56.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R56.9 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under R56.9. Per CMS ICD-10-CM Tabular 2026.
- Convulsion disorder
- Fit NOS
- Recurrent convulsions
- Seizure(s) (convulsive) 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.
Medicare LCD Coverage for R56.9
Local Coverage Determinations (LCDs) from CMS MACs that list R56.9 as a covered diagnosis.
Showing top 10 of 364 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R56.9.
3 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with R56.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99281 Emergency department visit for level 1 patient Emergency Medicine
- 99282 Emergency department visit for level 2 patient Emergency Medicine
- 99283 Emergency department visit for level 3 patient Emergency Medicine
- 99284 Emergency department visit for level 4 patient Emergency Medicine
- 99285 Emergency department visit for level 5 patient Emergency Medicine
- 95819 EEG awake and asleep — epilepsy, generalized seizures, absence seizures, focal seizures, seizure NOS, fasciculations, syncope, encephalopathy, cognitive decline, aphasia, migraine, headache, insomnia Neurology
- 95816 EEG awake only — epilepsy, seizures, encephalopathy, cognitive decline, syncope Neurology
Convert R56.9 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 |
|---|---|---|
| R56.9 | 78039 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R56.9
Other codes in section R50-R69 (General symptoms and signs).
ICD-10 R56.9, Billing FAQ
Is ICD-10 code R56.9 billable? +
Yes, R56.9 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 R56.9? +
ICD-10 R56.9 includes: Convulsion disorder; Fit NOS; Recurrent convulsions, and 1 more clinical synonyms.
Does R56.9 affect Medicare Advantage HCC risk adjustment? +
Yes. R56.9 maps to CMS-HCC v28 category 79. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with R56.9? +
Procedures frequently paired with R56.9 include: 99281, 99282, 99283, 99284, 99285.
What ICD-9 codes does R56.9 map to? +
Per CMS GEMs, R56.9 maps to ICD-9 codes: 78039. 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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