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E75.10 ICD-10-CM Code: Unspecified gangliosidosis

E75.10 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools

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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)

E75.10

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Unspecified gangliosidosis

A metabolic disorder where fatty substances called gangliosides abnormally accumulate in cells, but the specific type of gangliosidosis has not been identified.

Buddy the Bee presenting code insight

Buddy Insight

Unspecified gangliosidosis serves as a catch-all code when a gangliosidosis has been diagnosed but the specific type (GM1, GM2, or other variant) has not been determined.

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

HCC 52

RAF 0.346

ACA/HHS

HCC 119

Varies by metal level

ESRD/PACE

HCC 52

RAF 0.042

RXHCC

HCC 41

RAF 3.081

Code Book Path

Official
E75Disorders of sphingolipid metabolism and other lipid storage disorders
E75.1Other and unspecified gangliosidosis
E75.10Unspecified gangliosidosis

Inclusion Terms

Official
  • Gangliosidosis NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E75.10 in this effective period.

Related Child Codes

Official
E75.11Mucolipidosis IV
E75.19Other gangliosidosis

Includes

Official

ICD-10-CM does not list Includes notes for E75.10 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E75.10 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E75.10 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E75.10 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E75.10 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Provider diagnosis of gangliosidosis
Biochemical evidence of ganglioside accumulation
Documentation of why specific type has not been determined
Neurological assessment documenting current functional status

MEAT Support

HCC Buddy guidance
Provider diagnosis of gangliosidosis
Biochemical evidence of ganglioside accumulation
Documentation of why specific type has not been determined
Neurological assessment documenting current functional status

Audit Caution

HCC Buddy guidance
Using this code when the specific gangliosidosis type has been identified through enzyme assays
Not differentiating between GM1 and GM2 gangliosidosis when enzyme testing is available
Accepting this non-specific code without querying for additional diagnostic information
Failing to code the neurological manifestations as additional diagnoses

Common Mistakes

HCC Buddy guidance
E75.00 — GM2 gangliosidosis, unspecified: more specific within the GM2 category
E75.02 — Tay-Sachs disease: specific GM2 gangliosidosis
E75.01 — Sandhoff disease: specific GM2 gangliosidosis
E75.11 — Mucolipidosis IV: distinct lysosomal storage disorder

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E75.10 an HCC code?

Yes. E75.10 maps to Dementia Without Complication under the V24 model but is not retained in V28.

Code
E75.10
Description
Unspecified gangliosidosis
HCC (V28)
No CMS-HCC V28 mapping
RAF
—
Billable
Yes
Payment year
2026

HCC Category Mapping

V24HCC 52, Dementia Without Complication
0.346
ESRDHCC 52, Dementia Without Complication
0.042
RxHCCHCC 41, Lysosomal Storage Disorders
3.081

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work E75.10 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E75.10

For E75.10 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E75.10 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E75.10 is the ICD-10-CM diagnosis code for unspecified gangliosidosis. A metabolic disorder where fatty substances called gangliosides abnormally accumulate in cells, but the specific type of gangliosidosis has not been identified. E75.10 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

Under the older CMS-HCC V24 model, E75.10 maps to Dementia Without Complication (HCC 52) with a community, non-dual, aged base RAF weight of 0.346. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

This is a non-specific code; attempt to obtain genetic testing results or more specific clinical diagnosis. Because E75.10 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E75.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This is a non-specific code; attempt to obtain genetic testing results or more specific clinical diagnosis
  • •Query the provider to determine if additional testing can identify the specific gangliosidosis type

Clinical Significance

Unspecified gangliosidosis serves as a catch-all code when a gangliosidosis has been diagnosed but the specific type (GM1, GM2, or other variant) has not been determined. Gangliosidoses are devastating lysosomal storage disorders causing progressive neurodegeneration. Identifying the specific type is essential for genetic counseling, prognosis, and any available disease-specific therapies.

Documentation Requirements

  • ✓Provider diagnosis of gangliosidosis
  • ✓Biochemical evidence of ganglioside accumulation
  • ✓Documentation of why specific type has not been determined
  • ✓Neurological assessment documenting current functional status
  • ✓Plan for further diagnostic workup including enzyme assays and genetic testing

Commonly Confused Codes

  • •E75.00: GM2 gangliosidosis, unspecified: more specific within the GM2 category
  • •E75.02: Tay-Sachs disease: specific GM2 gangliosidosis
  • •E75.01: Sandhoff disease: specific GM2 gangliosidosis
  • •E75.11: Mucolipidosis IV: distinct lysosomal storage disorder
  • •E75.19: Other gangliosidosis: for identified types not GM2

Child Codes

E75.10Unspecified gangliosidosis
E75.11Mucolipidosis IV
E75.19Other gangliosidosis

Code Hierarchy

└E75Disorders of sphingolipid metabolism and other lipid storage disorders└E75.1Other and unspecified gangliosidosis└E75.10Unspecified gangliosidosis
└E75.10Unspecified gangliosidosis

Because E75.10 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

Work E75.10 in HCC Buddy

Open E75.10 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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