G36.9: Acute disseminated demyelination, unspecified

Risk adjustment

G36.9 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 198 Multiple Sclerosis0.647 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

G36.9 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A53052Billing and Coding: Home Health Speech-Language Pathology
• A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
• A56551Billing and Coding: Visual Fields Testing
• A56612Billing and Coding: CT of the Head