G40.119 ICD-10-CM Code: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G40.119
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLocalization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus
A type of epilepsy caused by a known brain condition with simple partial seizures that is difficult to control with medication, without current prolonged seizure activity.
Buddy Insight
This code captures symptomatic focal epilepsy with simple partial seizures that are drug-resistant (intractable) but without current status epilepticus.
CMS-HCC V28
MappedHCC 201
RAF 0.262
CMS-HCC V24
MappedHCC 79
RAF 0.244
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 79
RAF 0.0
RXHCC
MappedHCC 163
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for G40.119 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G40.119 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G40.119 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G40.119 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G40.119 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G40.119 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G40.119 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G40.119 an HCC code?
Yes. G40.119 maps to Seizure Disorders and Convulsions under the CMS-HCC V28 risk adjustment model (and Seizure Disorders and Convulsions under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for G40.119
For G40.119to 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 G40.119 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
G40.119 is the ICD-10-CM diagnosis code for localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures, intractable, without status epilepticus. A type of epilepsy caused by a known brain condition with simple partial seizures that is difficult to control with medication, without current prolonged seizure activity. G40.119 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering episodic and paroxysmal disorders (g40-g47).
Under the CMS-HCC V28 risk adjustment model, G40.119 maps to Seizure Disorders and Convulsions (HCC 201) with a community, non-dual, aged base RAF weight of 0.262. Under the older V24 model, G40.119 mapped to the same category but with a base RAF weight of 0.244, V28 recalibrated weights across the entire model. 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.
The '11' indicates symptomatic with simple partial seizures that are intractable; the final '9' indicates no status epilepticus. Because G40.119 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 G40.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The '11' indicates symptomatic with simple partial seizures that are intractable; the final '9' indicates no status epilepticus
- •Document medication trials and failures to support the 'intractable' designation
Clinical Significance
This code captures symptomatic focal epilepsy with simple partial seizures that are drug-resistant (intractable) but without current status epilepticus. These patients have ongoing seizures despite adequate medication trials and may be candidates for surgical evaluation. The symptomatic designation identifies an underlying structural or metabolic cause contributing to the drug resistance.
Documentation Requirements
- ✓Documentation of symptomatic focal epilepsy with identified underlying cause
- ✓Simple partial seizure type documented with preservation of consciousness
- ✓Evidence of intractability: documentation of failed antiepileptic medication trials
- ✓Ongoing seizure frequency despite medication compliance
- ✓Confirmation patient is NOT in status epilepticus
- ✓Documentation of the underlying cause and any surgical candidacy evaluation
Commonly Confused Codes
- •G40.109 — Same type, NOT intractable; medication responsive version
- •G40.111 — Same type, intractable, WITH status epilepticus; acute emergency presentation
- •G40.219 — Symptomatic focal with COMPLEX partial seizures, intractable; different seizure type
- •G40.019 — IDIOPATHIC focal epilepsy, intractable; no identified cause
- •G40.919 — Epilepsy unspecified, intractable; less specific