G40.B11 ICD-10-CM Code: Juvenile myoclonic epilepsy, intractable, with status epilepticus
G40.B11 maps to CMS-HCC V28 201. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G40.B11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceJuvenile myoclonic epilepsy, intractable, with status epilepticus
Juvenile myoclonic epilepsy that does not respond adequately to medication treatment, with the patient currently experiencing status epilepticus, which is a serious condition of prolonged or repeated seizures.
Buddy Insight
Intractable juvenile myoclonic epilepsy with status epilepticus is an uncommon but serious presentation.
CMS-HCC V28
MappedHCC 201
Coefficient HCC 201: 0.245 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 120
Code-level coefficient reference
ESRD/PACE
MappedHCC 79
Code-level coefficient reference
RXHCC
MappedHCC 163
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for G40.B11. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from G00-G99, G40
- certain infectious and parasitic diseases (A00-B99)Inherited from G00-G99, G40
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from G00-G99, G40
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from G00-G99, G40
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from G00-G99, G40
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from G00-G99, G40
- neoplasms (C00-D49)Inherited from G00-G99, G40
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from G00-G99, G40
- hippocampal sclerosis (G93.81)Inherited from G00-G99, G40
- mesial temporal sclerosis (G93.81)Inherited from G00-G99, G40
- temporal sclerosis (G93.81)Inherited from G00-G99, G40
- Todd's paralysis (G83.84)Inherited from G00-G99, G40
Related Codes
Includes
OfficialNo Includes notes are included in this display for G40.B11. Check the code and parent instructions in the Code Book.
Excludes 1
Official- conversion disorder with seizures (F44.5)Inherited from G40
- convulsions NOS (R56.9)Inherited from G40
- post traumatic seizures (R56.1)Inherited from G40
- seizure (convulsive) NOS (R56.9)Inherited from G40
- seizure of newborn (P90)Inherited from G40
Code First
OfficialNo Code First sequencing instructions are included in this display for G40.B11. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for G40.B11. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for G40.B11. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is G40.B11 an HCC code?
Yes. G40.B11 (Juvenile myoclonic epilepsy, intractable, with status epilepticus) maps to HCC 201, Seizure Disorders and Convulsions under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.245. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: G40.B11 is billable and maps to V28 HCC 201, Seizure Disorders and Convulsions. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- G40.B11
- Description
- Juvenile myoclonic epilepsy, intractable, with status epilepticus
- HCC (V28)
- HCC 201 — Seizure Disorders and Convulsions
- RAF reference coefficient
- 0.245
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work G40.B11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for G40.B11
For G40.B11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
G40.B11 is the ICD-10-CM diagnosis code for juvenile myoclonic epilepsy, intractable, with status epilepticus. Juvenile myoclonic epilepsy that does not respond adequately to medication treatment, with the patient currently experiencing status epilepticus, which is a serious condition of prolonged or repeated seizures. G40.B11 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.B11 maps to Seizure Disorders and Convulsions (HCC 201) with a source-labeled community, non-dual, aged reference coefficient of 0.245. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Document that seizures are intractable (drug-resistant) and that status epilepticus is present during the encounter. For G40.B11, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for G40.B11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document that seizures are intractable (drug-resistant) and that status epilepticus is present during the encounter
- •Status epilepticus is a medical emergency; ensure appropriate emergency care documentation is included
Clinical Significance
Intractable juvenile myoclonic epilepsy with status epilepticus is an uncommon but serious presentation. While JME typically responds well to appropriate medications, some patients have drug-resistant forms, and status epilepticus in this context is a medical emergency. Treatment-resistant JME may indicate incorrect medication choice (some antiepileptics worsen myoclonic seizures) rather than true pharmacoresistance.
Documentation Requirements
- ✓Confirmed JME diagnosis
- ✓Documentation of intractability with failed medication trials
- ✓Active status epilepticus during the encounter
- ✓Complete medication history including agents tried and failed
- ✓Assessment for medication appropriateness (avoiding seizure-worsening drugs)
- ✓Emergency interventions provided
Commonly Confused Codes
- •G40.B01: JME, NOT intractable, with status epilepticus
- •G40.B19: JME, intractable, WITHOUT status epilepticus
- •G40.C11: Lafora disease, intractable, with status epilepticus; progressive condition unlike JME
- •G40.A11: Absence epilepsy, intractable, with status epilepticus
- •G40.911: Unspecified epilepsy, intractable, with status epilepticus