G04.01: Postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious ADEM)
G04.01 is a billable, specific ICD-10-CM code for postinfectious acute disseminated encephalitis and encephalomyelitis (postinfectious adem). It is valid for submission on a claim.
Check G04.01 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Excludes1 inherited from the categories above G04.01
A category’s note binds every code beneath it.
Written on G04.0: Acute disseminated encephalitis and encephalomyelitis (ADEM)
Excludes2 inherited from the categories above G04.01
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with G04.01
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
G04.01 is named in 8 Medicare coverage policies: 8 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56551Billing and Coding: Visual Fields Testing
- A56771Billing and Coding: Special Electroencephalography
- A56799Billing and Coding: Visual Fields Testing
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Alphabetic index entries that lead here
- Encephalitis›postinfectious NEC
- Encephalomyelitis›postinfectious NEC
- Leukoencephalitis›postinfectious
- Encephalomyelitis›acute disseminated›infectious
- Encephalomyelitis›acute disseminated›postinfectious
- Encephalitis›acute›disseminated›infectious
- Encephalitis›acute›disseminated›postinfectious
- Meningoencephalomyelitis›acute NEC›disseminated›postinfectious
Code history
Unchanged in every release from FY2024 to FY2027.