G40.411
BillableOther generalized epilepsy and epileptic syndromes, intractable, with status epilepticus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G40.411 an HCC code?
Yes. G40.411 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 G40.411
For G40.411 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 G40.411 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.411 is the ICD-10-CM diagnosis code for other generalized epilepsy and epileptic syndromes, intractable, with status epilepticus. This code describes a severe form of epilepsy where seizures occur throughout the brain and cannot be controlled with medication, and the patient is currently experiencing status epilepticus (a prolonged or repeated seizure emergency). This is a serious neurological condition requiring immediate medical intervention. G40.411 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, G40.411 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, G40.411 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.
Verify documentation confirms both intractability (drug-resistant) and active status epilepticus before assigning this code, as status epilepticus is a time-specific acute condition. Because G40.411 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 G40.411 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation confirms both intractability (drug-resistant) and active status epilepticus before assigning this code, as status epilepticus is a time-specific acute condition
- •Status epilepticus is a medical emergency; ensure this code is used only when the patient is actively experiencing prolonged or recurrent seizures without full recovery between episodes
Clinical Significance
Intractable other generalized epilepsy with status epilepticus represents the most severe presentation in this code family — drug-resistant seizures involving both hemispheres with a life-threatening prolonged seizure emergency. These patients require intensive medical management, often ICU-level care, and may be candidates for surgical intervention or neurostimulation devices. This combination indicates exceptionally high resource utilization.
Documentation Requirements
- ✓Explicit documentation of intractable or drug-resistant epilepsy (pharmacoresistant)
- ✓Evidence of failed trials of at least two appropriately chosen antiepileptic drugs
- ✓Documentation of active status epilepticus during the encounter
- ✓Emergency interventions and treatments administered
- ✓Specific type of generalized epilepsy and underlying etiology if known
- ✓Current and prior medication history demonstrating intractability
Commonly Confused Codes
- •G40.401 — Same epilepsy type with status epilepticus but NOT intractable; seizures respond to medication
- •G40.419 — Same epilepsy type, intractable, but WITHOUT status epilepticus
- •G40.311 — Generalized IDIOPATHIC epilepsy, intractable, with status epilepticus
- •G40.803 — Other epilepsy (unclassified type), intractable, with status epilepticus
- •G40.911 — UNSPECIFIED epilepsy, intractable, with status epilepticus; less specific