Is ICD-10-CM code G12 billable?

No, G12 (Spinal muscular atrophy and related syndromes) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code G12 belong to?

G12 belongs to Chapter 6 of the ICD-10-CM tabular list: G00–G99 (Diseases of the Nervous System).

G12Not billable, use a more specific code below

Spinal muscular atrophy and related syndromes

In Systemic atrophies primarily affecting the central nervous system (G10-G14), chapter 6: Diseases of the Nervous System

11 billable codes under G12: all are a CC; all map to HCC 190 (Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease, Spinal Muscular Atrophy).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers default dominant or nondominant side for hemiplegia and monoplegia, and use and sequencing of G89 pain codes, including postoperative, chronic, and neoplasm-related pain.

Dominant/nondominant side (page 45)
Pain - Category G89 (page 45)

Read Section I.C.6 (page 45)

All codes under G12

G12 can't be used on a claim. Pick a billable code below; grey headings group them.

G12 MS-DRGs

As the principal diagnosis, all 11 billable codes under G12 group to MS-DRG 056 or 057 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) is a group of genetic diseases that damages and kills motor neurons. Motor neurons are a type of nerve cell in the spinal cord and lower part of the brain. They control movement in your arms, legs, face, chest, throat, and tongue.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.