G81.13: Spastic hemiplegia affecting right nondominant side

Risk adjustment

G81.13 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 253 Hemiplegia/Hemiparesis0.387 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

G81.13 is named in 43 Medicare coverage policies: 43 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52992Billing and Coding: Non-Invasive Cerebrovascular Arterial Studies
• A53057Billing and Coding: Home Health Occupational Therapy
• A53058Billing and Coding: Home Health Physical Therapy
• A53064Billing and Coding: Outpatient Occupational Therapy