G72.49 ICD-10-CM Code: Other inflammatory and immune myopathies, not elsewhere classified
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Diseases of myoneural junction and muscle (G70-G73)
G72.49
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther inflammatory and immune myopathies, not elsewhere classified
Muscle inflammation or immune-related muscle disorders that do not fit into other specific categories. These conditions involve the immune system attacking or inflaming muscle tissue.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Inflammatory myopathy NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G72.49 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G72.49 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G72.49 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G72.49 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G72.49 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G72.49 in this effective period.
Buddy Documentation Tip
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 G72.49 an HCC code?
No. G72.49 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
G72.49 is the ICD-10-CM diagnosis code for other inflammatory and immune myopathies, not elsewhere classified. Muscle inflammation or immune-related muscle disorders that do not fit into other specific categories. These conditions involve the immune system attacking or inflaming muscle tissue. G72.49 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).
G72.49 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Use this code when inflammatory myopathy is confirmed but does not meet criteria for dermatomyositis, polymyositis, or inclusion body myositis.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G72.49 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when inflammatory myopathy is confirmed but does not meet criteria for dermatomyositis, polymyositis, or inclusion body myositis
- •Document any autoimmune markers or antibody results found on testing to support the diagnosis