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v1.0.0
ICD-10 Guide
ICD-10 CodesG12.1

G12.1

Billable

Other inherited spinal muscular atrophy

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

Code Description

ICD-10 G12.1 is a billable code used to indicate a diagnosis of other inherited spinal muscular atrophy.

Key Diagnostic Point:

Other inherited spinal muscular atrophy (G12.1) encompasses a group of genetic disorders characterized by progressive muscle weakness and atrophy due to the degeneration of motor neurons in the spinal cord and brainstem. Unlike the more common types of spinal muscular atrophy (SMA), such as SMA type I, II, and III, which are primarily caused by mutations in the SMN1 gene, G12.1 includes various rare forms of SMA that may be linked to different genetic mutations. These conditions can manifest at any age and may present with varying degrees of severity. Symptoms typically include muscle weakness, reduced muscle tone, and difficulties with movement and coordination. The pathophysiology involves the loss of anterior horn cells in the spinal cord, leading to muscle denervation and subsequent atrophy. Diagnosis is often confirmed through genetic testing, electromyography, and clinical evaluation. Management focuses on supportive care, including physical therapy, nutritional support, and respiratory care, as there is currently no cure for these inherited conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of genetic mutations associated with the condition
  • Overlap with other motor neuron diseases
  • Need for precise genetic testing documentation
  • Potential for misclassification with other types of SMA

Audit Risk Factors

  • Inadequate documentation of genetic testing results
  • Misdiagnosis due to symptom overlap with other conditions
  • Failure to specify the type of inherited spinal muscular atrophy
  • Lack of comprehensive clinical evaluation notes

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed clinical notes including neurological examination findings, genetic testing results, and treatment plans.

Common Clinical Scenarios

Diagnosis of inherited spinal muscular atrophy in pediatric and adult patients, management of symptoms, and coordination of multidisciplinary care.

Billing Considerations

Ensure accurate documentation of the specific type of SMA and any associated genetic findings.

Genetics

Documentation Requirements

Genetic test results, family history, and detailed patient assessments.

Common Clinical Scenarios

Evaluation of patients with suspected genetic disorders, counseling families about inheritance patterns, and discussing potential interventions.

Billing Considerations

Documentation must clearly outline the genetic basis of the condition to support coding.

Coding Guidelines

Inclusion Criteria

Use G12.1 When
  • According to ICD
  • 10 coding guidelines, G12
  • 1 should be used when the specific type of inherited spinal muscular atrophy is not classified elsewhere
  • Coders should ensure that the diagnosis is supported by clinical documentation and genetic testing results

Exclusion Criteria

Do NOT use G12.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

96160CPT Code

Health risk assessment

Clinical Scenario

Used during initial evaluations for patients with G12.1 to assess overall health and risks.

Documentation Requirements

Complete health risk assessment form and clinical notes.

Specialty Considerations

Neurology specialists should ensure comprehensive assessments are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of inherited spinal muscular atrophy, improving the accuracy of data collection and reimbursement processes. G12.1 provides a distinct code for rare forms of SMA, enhancing clinical understanding and management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of inherited spinal muscular atrophy, improving the accuracy of data collection and reimbursement processes. G12.1 provides a distinct code for rare forms of SMA, enhancing clinical understanding and management.

Reimbursement & Billing Impact

reimbursement processes. G12.1 provides a distinct code for rare forms of SMA, enhancing clinical understanding and management.

Resources

Clinical References

  • •
    National Institute of Neurological Disorders and Stroke

Coding & Billing References

  • •
    National Institute of Neurological Disorders and Stroke

Frequently Asked Questions

What is the difference between G12.1 and G12.0?

G12.1 refers to other inherited forms of spinal muscular atrophy not classified under the more common types, such as G12.0, which specifically denotes spinal muscular atrophy type I.