G71.09 ICD-10-CM Code: Other specified muscular dystrophies
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Diseases of myoneural junction and muscle (G70-G73)
G71.09
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified muscular dystrophies
A group of inherited muscle diseases that cause progressive weakness and wasting of muscles, not classified as other specific types of muscular dystrophy.
Buddy Insight
Other specified muscular dystrophies captures muscular dystrophy types that have been identified but do not fit into the classified categories, such as Emery-Dreifuss muscular dystrophy, oculopharyngeal muscular dystrophy, or distal muscular dystrophies.
CMS-HCC V28
MappedHCC 197
RAF 0.0
CMS-HCC V24
MappedHCC 76
RAF 0.358
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 76
RAF 0.0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Benign scapuloperoneal muscular dystrophy with early contractures [Emery-Dreifuss]
- Congenital muscular dystrophy NOS
- Congenital muscular dystrophy with specific morphological abnormalities of the muscle fiber
- Distal muscular dystrophy
- Ocular muscular dystrophy
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G71.09 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G71.09 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G71.09 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G71.09 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G71.09 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G71.09 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G71.09 an HCC code?
Yes. G71.09 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 G71.09
For G71.09to 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 G71.09 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
G71.09 is the ICD-10-CM diagnosis code for other specified muscular dystrophies. A group of inherited muscle diseases that cause progressive weakness and wasting of muscles, not classified as other specific types of muscular dystrophy. G71.09 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, G71.09 maps to Muscular Dystrophy (HCC 197) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, G71.09 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.
Use this code only when the specific type of muscular dystrophy cannot be identified; always attempt to determine the exact subtype first. Because G71.09 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 G71.09 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific type of muscular dystrophy cannot be identified; always attempt to determine the exact subtype first
- •Document the pattern of muscle involvement and age of onset to support medical necessity and help with future classification
Clinical Significance
Other specified muscular dystrophies captures muscular dystrophy types that have been identified but do not fit into the classified categories, such as Emery-Dreifuss muscular dystrophy, oculopharyngeal muscular dystrophy, or distal muscular dystrophies. Accurate coding ensures that patients with these less common but clinically significant conditions are properly represented in risk adjustment.
Documentation Requirements
- ✓Provider's documentation of the specific type of muscular dystrophy
- ✓Clinical features distinguishing it from classified types (Duchenne/Becker, facioscapulohumeral, limb girdle, myotonic)
- ✓Genetic testing or muscle biopsy results when available
- ✓Functional status and disease progression pattern
- ✓Associated complications: cardiac, respiratory, swallowing dysfunction
- ✓Current treatment and management plan
Commonly Confused Codes
- •G71.00: Muscular dystrophy, unspecified should be used only when the type is truly unknown; G71.09 is for identified types without specific codes
- •G71.01: Duchenne or Becker muscular dystrophy has its own specific code
- •G71.02: Facioscapulohumeral muscular dystrophy has its own specific code
- •G71.11: Myotonic muscular dystrophy has its own specific code