G71.031
BillableAutosomal dominant limb girdle muscular dystrophy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.031 an HCC code?
Yes. G71.031 maps to Muscular Dystrophy under the CMS-HCC V28 risk adjustment model (and Muscular Dystrophy 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 G71.031
For G71.031 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 G71.031 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.031 is the ICD-10-CM diagnosis code for autosomal dominant limb girdle muscular dystrophy. A genetic muscle weakness disorder affecting the hip and shoulder muscles that is inherited in an autosomal dominant pattern, meaning only one copy of the mutated gene is needed to cause the disease. G71.031 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering diseases of myoneural junction and muscle (g70-g73).
Under the CMS-HCC V28 risk adjustment model, G71.031 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.031 mapped to the same category but with a base RAF weight of 0.358 — 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.
Verify family history documentation to confirm autosomal dominant inheritance pattern. Because G71.031 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 G71.031 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify family history documentation to confirm autosomal dominant inheritance pattern
- •Link to genetic testing results when available to support the specific subtype diagnosis
Clinical Significance
Autosomal dominant limb girdle muscular dystrophy is a group of genetic muscle disorders affecting the proximal hip and shoulder muscles with dominant inheritance pattern. Though generally milder than recessive forms, it causes progressive disability and requires ongoing multidisciplinary care. Specific genetic typing supports accurate prognostication and potential eligibility for gene-targeted therapies.
Documentation Requirements
- ✓Genetic testing confirming autosomal dominant inheritance pattern
- ✓Clinical findings: proximal weakness in hip and shoulder girdle muscles
- ✓Family history consistent with dominant inheritance (affected parent)
- ✓Muscle biopsy findings when available
- ✓Functional status: ambulation, ability to rise from chair, arm elevation
- ✓Provider's explicit diagnosis specifying autosomal dominant limb girdle muscular dystrophy