G40.419
BillableOther generalized epilepsy and epileptic syndromes, intractable, without status epilepticus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G40.419 an HCC code?
Yes. G40.419 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 G40.419
For G40.419 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 G40.419 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.419 is the ICD-10-CM diagnosis code for other generalized epilepsy and epileptic syndromes, intractable, without status epilepticus. A generalized epilepsy of a type other than idiopathic that is difficult to control with medication, and the patient is not currently in status epilepticus. G40.419 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, G40.419 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, G40.419 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.
Document the specific etiology of the secondary generalized epilepsy to provide complete clinical context. Because G40.419 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 G40.419 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific etiology of the secondary generalized epilepsy to provide complete clinical context
- •Note all failed medication trials and any surgical or device-based interventions being considered
Clinical Significance
Intractable other generalized epilepsy without status epilepticus identifies patients with drug-resistant generalized seizures who are not currently in a seizure emergency. These patients have failed adequate trials of antiepileptic medications and typically require complex multi-drug regimens, specialist referrals, and may be evaluated for surgical or device-based interventions. This represents a high-complexity chronic condition with substantial ongoing healthcare needs.
Documentation Requirements
- ✓Explicit documentation that epilepsy is intractable, drug-resistant, or pharmacoresistant
- ✓List of antiepileptic drugs tried and failed (minimum two adequate trials)
- ✓Confirmation that status epilepticus is NOT present at the encounter
- ✓Specific type of generalized epilepsy and etiology
- ✓Current medication regimen and management plan
- ✓Documentation of any advanced treatment considerations (surgery, VNS, responsive neurostimulation)