Question 1

What is ICD-10 code G92.9?

Accepted Answer

G92.9 is the ICD-10-CM diagnosis code for unspecified toxic encephalopathy. Brain damage or dysfunction caused by exposure to toxic substances, but the specific toxic agent or cause has not been identified or documented. G92.9 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).

G92.9 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.

Query the provider to identify the specific toxic substance when possible to assign a more specific code.

Question 2

Is G92.9 an HCC code?

Accepted Answer

No. G92.9 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is G92.9 billable?

Accepted Answer

Yes. G92.9 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. G92.9 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.

Question 4

What is the V28 vs V24 difference for G92.9?

Accepted Answer

G92.9 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards G92.9 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting G92.9?

Accepted Answer

Query the provider to identify the specific toxic substance when possible to assign a more specific code Review medication lists and environmental exposures documented in the medical record

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G92.9

Is G92.9 an HCC code?

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G92.9 ICD-10-CM Code: Unspecified toxic encephalopathy

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G92.9

Is G92.9 an HCC code?

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