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ICD-10 Guide
ICD-10 CodesG11.9

G11.9

Billable

Hereditary ataxia, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G11.9 is a billable code used to indicate a diagnosis of hereditary ataxia, unspecified.

Key Diagnostic Point:

Hereditary ataxia refers to a group of genetic disorders characterized by progressive loss of coordination and balance due to degeneration of the cerebellum and its connections. The condition can manifest in various forms, often with symptoms such as gait disturbances, difficulty with fine motor tasks, and speech problems. The unspecified designation indicates that the specific type of hereditary ataxia has not been determined, which can complicate diagnosis and treatment. Common hereditary ataxias include Friedreich's ataxia, spinocerebellar ataxias, and ataxia-telangiectasia, each with distinct genetic mutations and clinical presentations. Patients may also experience associated symptoms such as scoliosis, diabetes, and heart disease, depending on the specific type of ataxia. Diagnosis typically involves a combination of clinical evaluation, family history, genetic testing, and neuroimaging studies. Management focuses on symptomatic relief and supportive therapies, including physical therapy and occupational therapy, to enhance quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of hereditary ataxias with overlapping symptoms
  • Need for genetic testing to specify type
  • Potential for misdiagnosis with other neurodegenerative diseases
  • Documentation of family history is crucial

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Failure to document family history of ataxia
  • Misclassification of hereditary ataxia as acquired ataxia
  • Lack of detailed clinical notes on symptoms and progression

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Comprehensive neurological examination findings, family history, and results from genetic testing.

Common Clinical Scenarios

Patients presenting with progressive ataxia, gait instability, and coordination issues.

Billing Considerations

Ensure clear documentation of the patient's history and any genetic testing performed to support the diagnosis.

Genetics

Documentation Requirements

Detailed family pedigree, results of genetic tests, and any counseling provided.

Common Clinical Scenarios

Patients undergoing evaluation for hereditary ataxia based on family history or symptoms.

Billing Considerations

Accurate documentation of genetic findings is essential for coding and billing.

Coding Guidelines

Inclusion Criteria

Use G11.9 When
  • 10 guidelines specify that hereditary ataxia should be coded based on the specific type when known
  • 9 is used when the type is unspecified
  • Coders should ensure that documentation supports the diagnosis and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use G11.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

96116CPT Code

Neuropsychological testing

Clinical Scenario

Used to assess cognitive function in patients with hereditary ataxia.

Documentation Requirements

Document the rationale for testing and results.

Specialty Considerations

Neurologists should ensure comprehensive evaluation of cognitive and motor functions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hereditary ataxias, improving the ability to capture the nuances of these conditions. G11.9 serves as a catch-all for unspecified cases, but coders must ensure thorough documentation to support its use.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hereditary ataxias, improving the ability to capture the nuances of these conditions. G11.9 serves as a catch-all for unspecified cases, but coders must ensure thorough documentation to support its use.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hereditary ataxias, improving the ability to capture the nuances of these conditions. G11.9 serves as a catch-all for unspecified cases, but coders must ensure thorough documentation to support its use.

Resources

Clinical References

  • •
    National Ataxia Foundation

Coding & Billing References

  • •
    National Ataxia Foundation

Frequently Asked Questions

What should I document to support the use of G11.9?

Document a thorough clinical evaluation, family history of ataxia, and any genetic testing results. Ensure that the symptoms and progression of the condition are clearly outlined.