Question 1

What is ICD-10 code G93.81?

Accepted Answer

G93.81 is the ICD-10-CM diagnosis code for temporal sclerosis. Temporal sclerosis is a condition where brain tissue in the temporal lobe (the area near the temples) becomes scarred and hardened. This condition is often associated with epilepsy and can cause seizures. G93.81 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).

G93.81 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.

Verify whether this is mesial temporal sclerosis (MTS) or another type, as this distinction may affect treatment planning and should be documented by the physician.

Question 2

Is G93.81 an HCC code?

Accepted Answer

No. G93.81 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 G93.81 billable?

Accepted Answer

Yes. G93.81 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. G93.81 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 G93.81?

Accepted Answer

G93.81 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 model rewards G93.81 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting G93.81?

Accepted Answer

Verify whether this is mesial temporal sclerosis (MTS) or another type, as this distinction may affect treatment planning and should be documented by the physician When temporal sclerosis is associated with epilepsy, code both G93.81 and the appropriate epilepsy code (G40.x series) to capture the complete clinical picture

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G93.81

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G93.81 ICD-10-CM Code: Temporal sclerosis

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G93.81

Is G93.81 an HCC code?

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Work G93.81 in HCC Buddy