F78.A1 — SYNGAP1-related intellectual disability
F78.A1 is a billable, specific ICD-10-CM code for syngap1-related intellectual disability. It is valid for submission on a claim.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
Risk adjustment
F78.A1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
F78.A1 is named in 7 Medicare coverage policies — 5 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
- A57052Billing and Coding: Psychiatric Inpatient Hospitalization
- A57053Billing and Coding: Psychiatric Partial Hospitalization Programs
How F78.A1 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F78.A1.
- Disability, disabilities›intellectual›SYNGAP1-related
- Disability, disabilities›intellectual›genetic related›SYNGAP1-related
- Disability, disabilities›intellectual›with›pathogenic SYNGAP1(genetic) (variant)
- Disability, disabilities›intellectual›genetic related›with›pathogenic SYNGAP1(variant)
Related codes at this level
Codes that share F78.A. If F78.A1 is not quite right, the correct code is usually one of these.
Questions about F78.A1
- Is F78.A1 a billable ICD-10-CM code?
- Yes. F78.A1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F78.A1 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Intellectual Disabilities (F70-F79).