G12.21
BillableAmyotrophic lateral sclerosis
HCC Category Mapping
V28HCC 190 — Motor Neuron Disease, Including Amyotrophic Lateral Sclerosis
0.935V24HCC 73 — Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease
0.896ESRDHCC 73 — Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease
0.000RxHCCHCC 154 — Motor Neuron Disease
0.000What This Code Means
Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease that causes muscle weakness and paralysis by damaging nerve cells that control voluntary muscles. This condition gradually worsens over time and affects a person's ability to move, speak, eat, and breathe.
Coding Tips
- •ALS is a chronic progressive condition; ensure documentation clearly supports the diagnosis and specify the stage or severity if documented (onset, progression, affected body regions)
- •Code G12.21 is specific to ALS; do not confuse with other motor neuron diseases coded under G12.2x (such as progressive muscular atrophy G12.25 or primary lateral sclerosis G12.29)
Clinical Significance
Amyotrophic lateral sclerosis is one of the most devastating neurodegenerative diseases, causing progressive paralysis and death typically within 3-5 years of diagnosis. It involves both upper and lower motor neuron degeneration and drives extremely high healthcare costs including ventilator support, feeding tubes, communication devices, and expensive medications like riluzole and edaravone.
Documentation Requirements
- ✓El Escorial criteria or equivalent diagnostic criteria documented
- ✓Both upper motor neuron signs (spasticity, hyperreflexia) and lower motor neuron signs (atrophy, fasciculations) present
- ✓Electromyography findings consistent with widespread denervation
- ✓Rate of disease progression and affected body regions
- ✓Current respiratory function (forced vital capacity)
- ✓Treatment with disease-modifying medications (riluzole, edaravone, tofersen) if applicable
Commonly Confused Codes
G12.23 — Primary lateral sclerosis: upper motor neuron only, slower progression, better prognosisG12.25 — Progressive spinal muscle atrophy: lower motor neuron onlyG12.22 — Progressive bulbar palsy: bulbar-onset motor neuron diseaseG12.20 — Motor neuron disease, unspecified: do not use when amyotrophic lateral sclerosis is diagnosed
Code Hierarchy
└G12Spinal muscular atrophy and related syndromes└G12.2Motor neuron disease└G12.21Amyotrophic lateral sclerosis
└G12.21Amyotrophic lateral sclerosis