G36.0
BillableNeuromyelitis optica [Devic]
HCC Category Mapping
V28HCC 198 — Multiple Sclerosis
0.000V24HCC 77 — Multiple Sclerosis
0.476ESRDHCC 77 — Multiple Sclerosis
0.000RxHCCHCC 159 — Multiple Sclerosis
0.000What This Code Means
A rare autoimmune disease affecting the optic nerves and spinal cord, causing inflammation and demyelination that leads to vision loss and paralysis.
Coding Tips
- •Confirm diagnosis is specifically neuromyelitis optica (NMO) and not multiple sclerosis, as they are distinct conditions
- •Document involvement of optic nerves and spinal cord to support medical necessity
Clinical Significance
Neuromyelitis optica (Devic's disease) is a rare autoimmune demyelinating disorder affecting the optic nerves and spinal cord. It is now recognized as a distinct entity from multiple sclerosis, with different pathophysiology (aquaporin-4 antibodies), treatment approaches, and prognosis. Accurate identification is critical because standard multiple sclerosis treatments may worsen neuromyelitis optica.
Documentation Requirements
- ✓Provider documentation specifically stating neuromyelitis optica or Devic's disease
- ✓Aquaporin-4 (AQP4) antibody testing results (positive supports diagnosis)
- ✓Documentation of optic neuritis and/or transverse myelitis episodes
- ✓MRI findings showing longitudinally extensive transverse myelitis (3+ vertebral segments) and/or optic nerve inflammation
- ✓Current immunosuppressive treatment plan (eculizumab, inebilizumab, satralizumab)
- ✓Documentation of disease course including attack frequency and disability level
Excludes 1 — Do NOT code together
- optic neuritis NOS (H46)
Commonly Confused Codes
G35 — Multiple sclerosis; different pathology, different treatment, shorter spinal cord lesionsG37.81 — Myelin oligodendrocyte glycoprotein antibody disease (MOGAD); different antibody (MOG vs. AQP4) with different prognosisG36.9 — Acute disseminated demyelination, unspecified; too nonspecific when NMO is confirmedH46.00-H46.9 — Optic neuritis; may be a presenting symptom but does not capture the full NMO diagnosisG37.3 — Acute transverse myelitis; may be a feature of NMO but does not capture the underlying disease
Code Hierarchy
└G36Other acute disseminated demyelination└G36.0Neuromyelitis optica [Devic]
└G36.0Neuromyelitis optica [Devic]