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G40.B19 ICD-10-CM Code: Juvenile myoclonic epilepsy, intractable, without status epilepticus

G40.B19 maps to CMS-HCC V28 201. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)

G40.B19

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Juvenile myoclonic epilepsy, intractable, without status epilepticus

Juvenile myoclonic epilepsy that does not respond adequately to medication, but the patient is not currently experiencing prolonged or repeated seizure activity.

Buddy the Bee presenting code insight

Buddy Insight

Intractable juvenile myoclonic epilepsy without status epilepticus indicates ongoing drug-resistant seizures in a patient with JME who is not in acute crisis.

CMS-HCC V28

HCC 201

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 120

Code-level coefficient reference

ESRD/PACE

HCC 79

Code-level coefficient reference

RXHCC

HCC 163

Code-level coefficient reference

Code Book Path

Official
G40.BJuvenile myoclonic epilepsy [impulsive petit mal]
G40.B1Juvenile myoclonic epilepsy, intractable
G40.B19Juvenile myoclonic epilepsy, intractable, without status epilepticus

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for G40.B19 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G40.B19 in this effective period.

Related Child Codes

Official
G40.B11Juvenile myoclonic epilepsy, intractable, with status epilepticus

Includes

Official

ICD-10-CM does not list Includes notes for G40.B19 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G40.B19 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G40.B19 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G40.B19 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G40.B19 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Confirmed JME diagnosis
Documentation of intractability with list of failed medications
Absence of status epilepticus
Verification that appropriate JME medications were tried (valproate, levetiracetam)

MEAT Support

HCC Buddy guidance
Confirmed JME diagnosis
Documentation of intractability with list of failed medications
Absence of status epilepticus
Verification that appropriate JME medications were tried (valproate, levetiracetam)

Audit Caution

HCC Buddy guidance
Calling JME intractable when inappropriate medications were used (sodium channel blockers can worsen JME)
Not evaluating medication compliance in adolescent patients before coding intractable
Using generic intractable epilepsy codes when JME is specifically diagnosed
Failing to reassess the JME diagnosis when it proves truly intractable to appropriate therapy

Common Mistakes

HCC Buddy guidance
G40.B09 — JME, NOT intractable; seizures controlled
G40.B11 — JME, intractable, WITH status epilepticus
G40.A19 — Absence epilepsy, intractable; different syndrome
G40.C19 — Lafora disease, intractable; progressive condition

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.B19 an HCC code?

Yes. G40.B19 (Juvenile myoclonic epilepsy, intractable, without 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.B19 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.B19
Description
Juvenile myoclonic epilepsy, intractable, without status epilepticus
HCC (V28)
HCC 201 — Seizure Disorders and Convulsions
RAF reference coefficient
0.245
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 201, Seizure Disorders and Convulsions
0.245
ESRDHCC 79, Seizure Disorders and Convulsions
Not separately weighted
RxHCCHCC 163, Intractable Epilepsy
Not separately weighted

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.B19 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for G40.B19

For G40.B19 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.B19 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G40.B19 is the ICD-10-CM diagnosis code for juvenile myoclonic epilepsy, intractable, without status epilepticus. Juvenile myoclonic epilepsy that does not respond adequately to medication, but the patient is not currently experiencing prolonged or repeated seizure activity. G40.B19 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.B19 maps to Seizure Disorders and Convulsions (HCC 201) with a source-labeled community, non-dual, aged reference coefficient of 0.245. No V24 mapping is shown for G40.B19; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Confirm intractability is documented (seizures not controlled despite medication trials). Because G40.B19 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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.B19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm intractability is documented (seizures not controlled despite medication trials)
  • •Verify absence of status epilepticus at the time of encounter or documentation period

Clinical Significance

Intractable juvenile myoclonic epilepsy without status epilepticus indicates ongoing drug-resistant seizures in a patient with JME who is not in acute crisis. Since JME typically responds to appropriate medication, intractability should prompt review of the medication regimen for inappropriate agents and assessment for medication adherence, particularly in the adolescent population.

Documentation Requirements

  • ✓Confirmed JME diagnosis
  • ✓Documentation of intractability with list of failed medications
  • ✓Absence of status epilepticus
  • ✓Verification that appropriate JME medications were tried (valproate, levetiracetam)
  • ✓Assessment of medication adherence
  • ✓Current seizure frequency and impact on daily life

Commonly Confused Codes

  • •G40.B09: JME, NOT intractable; seizures controlled
  • •G40.B11: JME, intractable, WITH status epilepticus
  • •G40.A19: Absence epilepsy, intractable; different syndrome
  • •G40.C19: Lafora disease, intractable; progressive condition
  • •G40.919: Unspecified epilepsy, intractable; less specific

Child Codes

G40.B11Juvenile myoclonic epilepsy, intractable, with status epilepticus
HCC 201
G40.B19Juvenile myoclonic epilepsy, intractable, without status epilepticus
HCC 201

Code Hierarchy

└G40Epilepsy and recurrent seizures└G40.BJuvenile myoclonic epilepsy [impulsive petit mal]└G40.B1Juvenile myoclonic epilepsy, intractable└G40.B19Juvenile myoclonic epilepsy, intractable, without status epilepticus
└G40.B19Juvenile myoclonic epilepsy, intractable, without status epilepticus

Because G40.B19 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

G40.B19 maps to CMS-HCC V28 category 201, Seizure Disorders and Convulsions. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for G40.B19. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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