R56.9 ICD-10-CM Code: Unspecified convulsions
R56.9 maps to CMS-HCC V28 201. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) / General symptoms and signs (R50-R69)
R56.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified convulsions
Seizures or convulsions where the specific type or cause has not been determined or documented.
Buddy Insight
Unspecified convulsions represent seizure activity where the specific type, cause, or characteristics have not been determined, indicating need for further neurological evaluation.
CMS-HCC V28
MappedHCC 201
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 120
Code-level coefficient reference
ESRD/PACE
MappedHCC 79
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Convulsion disorder
- Fit NOS
- Recurrent convulsions
- Seizure(s) (convulsive) NOS
Excludes 2
Official- abnormal findings on antenatal screening of mother (O28.-)Inherited from R00-R99
- certain conditions originating in the perinatal period (P04-P96)Inherited from R00-R99
- signs and symptoms classified in the body system chaptersInherited from R00-R99
- signs and symptoms of breast (N63, N64.5)Inherited from R00-R99
Related Codes
Includes
OfficialNo Includes notes are included in this display for R56.9. Check the code and parent instructions in the Code Book.
Excludes 1
Official- dissociative convulsions and seizures (F44.5)Inherited from R56
- epileptic convulsions and seizures (G40.-)Inherited from R56
- newborn convulsions and seizures (P90)Inherited from R56
Code First
OfficialNo Code First sequencing instructions are included in this display for R56.9. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for R56.9. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for R56.9. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is R56.9 an HCC code?
Yes. R56.9 (Unspecified convulsions) maps to HCC 201, Seizure Disorders and Convulsions under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.245. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: R56.9 is billable and maps to V28 HCC 201, Seizure Disorders and Convulsions. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- R56.9
- Description
- Unspecified convulsions
- HCC (V28)
- HCC 201 — Seizure Disorders and Convulsions
- RAF reference coefficient
- 0.245
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work R56.9 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for R56.9
For R56.9, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
R56.9 is the ICD-10-CM diagnosis code for unspecified convulsions. Seizures or convulsions where the specific type or cause has not been determined or documented. R56.9 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering general symptoms and signs (r50-r69).
Under the CMS-HCC V28 risk adjustment model, R56.9 maps to Seizure Disorders and Convulsions (HCC 201) with a source-labeled community, non-dual, aged reference coefficient of 0.245. No V24 mapping is shown for R56.9; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code only when the type of convulsion cannot be specified; attempt to obtain more clinical detail. For R56.9, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for R56.9 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 type of convulsion cannot be specified; attempt to obtain more clinical detail
- •Review documentation for any indicators of febrile, post-traumatic, or other specific convulsion types
Clinical Significance
Unspecified convulsions represent seizure activity where the specific type, cause, or characteristics have not been determined, indicating need for further neurological evaluation. While less specific, this diagnosis still represents significant neurological symptoms requiring investigation and potential treatment to prevent recurrence and identify underlying causes.
Documentation Requirements
- ✓Documentation of seizure or convulsive activity
- ✓Witness description of episode
- ✓Duration and characteristics if known
- ✓Associated symptoms or triggers
- ✓Neurological examination findings
- ✓Investigations performed or planned
- ✓Response to any interventions
- ✓Follow-up care arrangements