G40.A11
BillableAbsence epileptic syndrome, 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.A11 an HCC code?
Yes. G40.A11 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.A11
For G40.A11to 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.A11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G40.A11 is the ICD-10-CM diagnosis code for absence epileptic syndrome, intractable, with status epilepticus. Absence epilepsy that is resistant to medication, currently experiencing status epilepticus. G40.A11 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.A11 maps to Seizure Disorders and Convulsions (HCC 201) with a community, non-dual, aged base RAF weight of 0.245. Under the older V24 model, G40.A11 mapped to the same category but with a base RAF weight of 0.220 — 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.
Intractable absence epilepsy is less common but more challenging to manage. Because G40.A11 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.A11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intractable absence epilepsy is less common but more challenging to manage
- •Ensure documentation supports medication resistance with specific drug trial failures
Clinical Significance
Intractable absence epileptic syndrome with status epilepticus is an uncommon but serious presentation where absence seizures are drug-resistant and the patient is in prolonged absence status. This is more challenging to manage than typical absence epilepsy and may indicate an atypical absence syndrome or evolution toward juvenile myoclonic epilepsy or other generalized epilepsy syndromes.
Documentation Requirements
- ✓Confirmed absence epilepsy diagnosis with EEG confirmation
- ✓Documentation of intractability with failed trials of first-line agents (ethosuximide, valproic acid)
- ✓Active absence status epilepticus during the encounter
- ✓Emergency interventions provided
- ✓Assessment for alternative or coexisting epilepsy syndromes
- ✓Complete medication history
Commonly Confused Codes
- •G40.A01 — Absence epilepsy with status epilepticus, NOT intractable
- •G40.A19 — Absence epilepsy, intractable, WITHOUT status epilepticus
- •G40.B11 — Juvenile myoclonic epilepsy, intractable, with status epilepticus; different syndrome
- •G40.411 — Other generalized epilepsy, intractable, with status epilepticus
- •G40.911 — Unspecified epilepsy, intractable, with status epilepticus