G31.09: Other frontotemporal neurocognitive disorder

Risk adjustment

G31.09 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 127 Dementia, Mild or Unspecified0.341 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

G31.09 is named in 15 Medicare coverage policies: 13 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
• A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
• A53134Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions
• A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders