What is ICD-10 code G91.4?

G91.4 is the ICD-10-CM diagnosis code for Hydrocephalus in diseases classified elsewhere. Hydrocephalus that develops as a secondary complication of another disease or condition, such as infection, hemorrhage, or malignancy. It belongs to the ICD-10-CM chapter for diseases of the nervous system (g00-g99). G91.4 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G91.4 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. G91.4 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. G91.4 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for G91.4?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. G91.4 is a payment HCC under V28 (Dementia, Mild or Unspecified) but was not retained as a payment HCC under V24. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting G91.4?

This code requires a secondary diagnosis code identifying the underlying disease causing the hydrocephalus Use the 'in diseases classified elsewhere' convention and code the primary condition first Because G91.4 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

G91.4 ICD-10 Code: Hydrocephalus in diseases

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupG91.4Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Other disorders of the nervous system (G89-G99)

G91.4

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

Hydrocephalus in diseases classified elsewhere

Hydrocephalus that develops as a secondary complication of another disease or condition, such as infection, hemorrhage, or malignancy.

Buddy Insight

CMS-HCC V28

Mapped

HCC 127

Dementia, Mild or Unspecified

RAF 0.464

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

G91Hydrocephalus

G91.4Hydrocephalus in diseases classified elsewhere

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for G91.4 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G91.4 in this effective period.

Related Child Codes

Official

G91.0Communicating hydrocephalus

G91.1Obstructive hydrocephalus

G91.2(Idiopathic) normal pressure hydrocephalus

G91.3Post-traumatic hydrocephalus, unspecified

G91.8Other hydrocephalus

Includes

Official

acquired hydrocephalus

Excludes 1

Official

hydrocephalus due to congenital toxoplasmosis (P37.1)

Code First

Official

underlying condition, such as:
congenital syphilis (A50.4-)
neoplasm (C00-D49)
plasminogen deficiency (E88.02)

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G91.4 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G91.4 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clear documentation of the underlying disease causing the hydrocephalus

Imaging confirming ventricular enlargement consistent with hydrocephalus

Clinical evidence linking the hydrocephalus to the underlying classified condition

Treatment status including any surgical intervention for the hydrocephalus

MEAT Support

HCC Buddy guidance

Clear documentation of the underlying disease causing the hydrocephalus

Imaging confirming ventricular enlargement consistent with hydrocephalus

Clinical evidence linking the hydrocephalus to the underlying classified condition

Treatment status including any surgical intervention for the hydrocephalus

Audit Caution

HCC Buddy guidance

Failing to code the underlying disease first, as G91.4 is a manifestation code requiring sequencing

Using this code without documenting the causal relationship between the underlying disease and hydrocephalus

Misapplying this code when the hydrocephalus is not directly caused by the classified underlying condition

Not recognizing the 'Code first' instructional note requiring the underlying condition to be sequenced before G91.4

Common Mistakes

HCC Buddy guidance

G91.0 — Communicating hydrocephalus: use when hydrocephalus stands alone without an underlying classified condition

G91.1 — Obstructive hydrocephalus: use when the mechanism is obstruction and no underlying classified condition applies

G91.8 — Other hydrocephalus: for specified types not elsewhere classified without an underlying disease

G91.9 — Hydrocephalus, unspecified: avoid when the type or cause is documented

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 G91.4 an HCC code?

Yes. G91.4 maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model.

HCC Category Mapping

V28HCC 127, Dementia, Mild or Unspecified

0.464

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 G91.4

For G91.4to 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 G91.4 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

G91.4 is the ICD-10-CM diagnosis code for hydrocephalus in diseases classified elsewhere. Hydrocephalus that develops as a secondary complication of another disease or condition, such as infection, hemorrhage, or malignancy. G91.4 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering other disorders of the nervous system (g89-g99).

Under the CMS-HCC V28 risk adjustment model, G91.4 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.464. G91.4 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.

This code requires a secondary diagnosis code identifying the underlying disease causing the hydrocephalus. Because G91.4 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 G91.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•This code requires a secondary diagnosis code identifying the underlying disease causing the hydrocephalus
•Use the 'in diseases classified elsewhere' convention and code the primary condition first

Clinical Significance

Hydrocephalus in diseases classified elsewhere is a manifestation code used when hydrocephalus develops secondary to another classified condition, such as neoplastic disease, infectious meningitis, or congenital toxoplasmosis. Proper sequencing requires the underlying disease to be coded first, making this a dependent code that reflects the complexity of multi-system disease management. Accurate capture is important for reflecting the true disease burden.

Documentation Requirements

✓Clear documentation of the underlying disease causing the hydrocephalus
✓Imaging confirming ventricular enlargement consistent with hydrocephalus
✓Clinical evidence linking the hydrocephalus to the underlying classified condition
✓Treatment status including any surgical intervention for the hydrocephalus
✓Current neurological status and impact on overall disease management

Excludes 1, Do NOT code together

hydrocephalus due to congenital toxoplasmosis (P37.1)

Code First

underlying condition, such as:
congenital syphilis (A50.4-)
neoplasm (C00-D49)
plasminogen deficiency (E88.02)

Commonly Confused Codes

•G91.0: Communicating hydrocephalus: use when hydrocephalus stands alone without an underlying classified condition
•G91.1: Obstructive hydrocephalus: use when the mechanism is obstruction and no underlying classified condition applies
•G91.8: Other hydrocephalus: for specified types not elsewhere classified without an underlying disease
•G91.9: Hydrocephalus, unspecified: avoid when the type or cause is documented