G93.45: Developmental and epileptic encephalopathy
G93.45 is a billable, specific ICD-10-CM code for developmental and epileptic encephalopathy. It is valid for submission on a claim.
Check G93.45 with the rest of the claim: free scrubberCode also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- , if applicable, associated disorders such as:
- developmental disorders of scholastic skills (F81.-)
- developmental disorder of speech and language (F80.-)
- epilepsy, by specific type (G40.-)
- intellectual disabilities (F70-F79)
- other neurodevelopmental disorder (F88)
- pervasive developmental disorders (F84.-)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Early infantile epileptic encephalopathy
Excludes2 inherited from the categories above G93.45
Not part of this code, but both may be coded when both are present.
Risk adjustment
G93.45 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 201 Seizure Disorders and Convulsions0.245 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
G93.45 is named in 6 Medicare coverage policies: 5 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A56562Billing and Coding: Health and Behavior Assessment/Interventionnot covered
- A56612Billing and Coding: CT of the Head
- A56619Billing and Coding: Nerve Conduction Studies and Electromyography
- A56771Billing and Coding: Special Electroencephalography
Alphabetic index entries that lead here
- Encephalopathy›developmental and epileptic
- Encephalopathy›early infantile epileptic
Code history
- addedFY2024-FY2027
Developmental and epileptic encephalopathy