G71.032
BillableAutosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is G71.032 an HCC code?
Yes. G71.032 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 G71.032
For G71.032 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 G71.032 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
G71.032 is the ICD-10-CM diagnosis code for autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction. A genetic muscle weakness disorder affecting the hip and shoulder muscles caused by calpain-3 protein dysfunction, inherited in an autosomal recessive pattern requiring two mutated gene copies. G71.032 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, G71.032 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.032 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.
Confirm genetic testing results specifically identifying calpain-3 mutations before coding. Because G71.032 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 G71.032 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm genetic testing results specifically identifying calpain-3 mutations before coding
- •Document both parents as carriers if family history is available
Clinical Significance
Autosomal recessive limb girdle muscular dystrophy due to calpain-3 dysfunction (LGMD2A/LGMDR1) is one of the most common forms of limb girdle muscular dystrophy. It presents with progressive proximal weakness and elevated creatine kinase, and has specific genetic implications for family counseling. Precise coding enables tracking of this specific genetic subtype and may support eligibility for clinical trials and targeted therapies.
Documentation Requirements
- ✓Genetic testing confirming CAPN3 gene mutation causing calpain-3 deficiency
- ✓Clinical presentation: proximal weakness, elevated creatine kinase
- ✓Muscle biopsy showing reduced or absent calpain-3 on Western blot when available
- ✓Autosomal recessive inheritance pattern documentation
- ✓Functional status assessment: ambulation, respiratory function
- ✓Provider's explicit diagnosis specifying calpain-3 dysfunction
Commonly Confused Codes
- •G71.031 — Autosomal dominant limb girdle muscular dystrophy has a different inheritance pattern
- •G71.033 — Limb girdle muscular dystrophy due to dysferlin dysfunction involves a different protein deficiency
- •G71.039 — Limb girdle muscular dystrophy, unspecified should not be used when calpain-3 mutation is confirmed
- •G71.038 — Other limb girdle muscular dystrophy is for identified subtypes without their own code, not for calpain-3