Question 1

What is ICD-10 code A80.4?

Accepted Answer

A80.4 is the ICD-10-CM diagnosis code for acute nonparalytic poliomyelitis. This is a viral infection caused by poliovirus that affects the nervous system but does not cause paralysis. The patient experiences symptoms like fever, muscle pain, and stiffness but maintains normal muscle function and movement. A80.4 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering viral and prion infections of the central nervous system (a80-a89).

A80.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Verify the clinical documentation confirms nonparalytic presentation; if paralysis develops, use A80.3 instead.

Question 2

Is A80.4 an HCC code?

Accepted Answer

No. A80.4 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is A80.4 billable?

Accepted Answer

Yes. A80.4 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. A80.4 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for A80.4?

Accepted Answer

A80.4 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards A80.4 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting A80.4?

Accepted Answer

Verify the clinical documentation confirms nonparalytic presentation; if paralysis develops, use A80.3 instead This code requires a 6th character to specify the poliovirus type (1, 2, or 3) - ensure complete code assignment (e.g., A80.41, A80.42, A80.43)

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A80.4

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A80.4 ICD-10-CM Code: Acute nonparalytic poliomyelitis

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A80.4

Is A80.4 an HCC code?

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