G04.1 — Tropical spastic paraplegia
G04.1 is a billable, specific ICD-10-CM code for tropical spastic paraplegia. It is valid for submission on a claim.
Risk adjustment
G04.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 182 Spinal Cord Disorders/Injuries0.478 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
G04.1 is named in 32 Medicare coverage policies — 32 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52465Knee Orthoses - Policy Article
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
How G04.1 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 G04.1.
- Paraplegia›tropical spastic
- Paraplegia›spastic›tropical
Related codes at this level
Codes that share G04. If G04.1 is not quite right, the correct code is usually one of these.
- G04.0Acute disseminated encephalitis and encephalomyelitis (ADEM)
- G04.2Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified
- G04.3Acute necrotizing hemorrhagic encephalopathy
- G04.8Other encephalitis, myelitis and encephalomyelitis
- G04.9Encephalitis, myelitis and encephalomyelitis, unspecified
Questions about G04.1
- Is G04.1 a billable ICD-10-CM code?
- Yes. G04.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does G04.1 sit in the tabular list?
- Diseases of the nervous system (G00-G99), in the block Inflammatory diseases of the central nervous system (G00-G09).