G40.822
BillableEpileptic spasms, not intractable, without status epilepticus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G40.822 an HCC code?
Yes. G40.822 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 G40.822
For G40.822 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 G40.822 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.822 is the ICD-10-CM diagnosis code for epileptic spasms, not intractable, without status epilepticus. Epileptic spasms that can be controlled with medication, not currently in a prolonged seizure state. G40.822 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, G40.822 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, G40.822 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.
Use this code when spasms are responsive to treatment and status epilepticus is not present. Because G40.822 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 G40.822 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when spasms are responsive to treatment and status epilepticus is not present
- •Document the medication regimen to support the 'not intractable' designation
Clinical Significance
Epileptic spasms that respond to treatment without status epilepticus. This may represent successfully treated infantile spasms or ongoing spasm disorder in remission from status. Early treatment of epileptic spasms is critical to minimize developmental impact, and medication-responsive cases have a better long-term prognosis than intractable presentations.
Documentation Requirements
- ✓Documentation of epileptic spasms diagnosis
- ✓Confirmation spasms are controlled with medication (not intractable)
- ✓Absence of status epilepticus
- ✓Current treatment regimen (ACTH, vigabatrin, or other agents)
- ✓Developmental milestone tracking
- ✓EEG findings and seizure frequency
Commonly Confused Codes
- •G40.821 — Epileptic spasms, not intractable, WITH status epilepticus
- •G40.824 — Epileptic spasms, INTRACTABLE, without status epilepticus
- •G40.812 — Lennox-Gastaut without status epilepticus; distinct syndrome
- •G25.3 — Myoclonus; non-epileptic myoclonic movements
- •G40.802 — Other epilepsy, not intractable; less specific