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G04.1 ICD-10-CM Code: Tropical spastic paraplegia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 inclusion terms · 1 Excludes1 · 7 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 72 · RxHCC V08 category 155

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 052 — SPINAL DISORDERS AND INJURIES WITH CC/MCC (MDC 01)
  • MS-DRG 053 — SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC (MDC 01)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 182 — Spinal Cord Disorders/Injuries

Other models: CMS-HCC V22 HCC 72 · RxHCC V08 HCC 155

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for G04.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on G04.1 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • acute ascending myelitis
  • meningoencephalitis
  • meningomyelitis

Source: inherited from G04

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from G04

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from G04

Coder workflow for G04.1

MedCoder structured workflow — derived from this code’s own official record

Before you code G04.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with G04.1. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in G04.1’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewG93.40

Consider G04.1. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).

Official instructions as workflow

  • Excludes1 — check before selecting G04.1(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with G04.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareG93.40

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of G04.1(7 notes)

    Coding workflow: The conditions named in this note are not included in G04.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareG37.3, G31.2, G35, G93.32, G37.4, G92.8

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition G04.1 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewG93.40

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Tropical spastic paraplegia is a billable ICD-10-CM diagnosis code (G04.1).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name G04.1 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: G03 — Meningitis due to other and unspecified causes (via G04.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: G95 — Other and unspecified diseases of spinal cord (via G04.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 138 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 052 (MDC 01), DRG 053 (MDC 01).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):NVS008 — Paralysis (other than cerebral palsy) (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

G11.0 — Congenital nonprogressive ataxia, G11.10 — Early-onset cerebellar ataxia, unspecified, G11.11 — Friedreich ataxia, G11.19 — Other early-onset cerebellar ataxia, G11.2 — Late-onset cerebellar ataxia, G11.3 — Cerebellar ataxia with defective DNA repair, G11.4 — Hereditary spastic paraplegia, G11.5 — Hypomyelination - hypogonadotropic hypogonadism - hypodontia, G11.6 — Leukodystrophy with vanishing white matter disease, G11.8 — Other hereditary ataxias, G11.9 — Hereditary ataxia, unspecified, G12.0 — Infantile spinal muscular atrophy, type I [Werdnig-Hoffman], G12.1 — Other inherited spinal muscular atrophy, G12.20 — Motor neuron disease, unspecified, G12.21 — Amyotrophic lateral sclerosis, G12.22 — Progressive bulbar palsy, G12.23 — Primary lateral sclerosis, G12.24 — Familial motor neuron disease, G12.25 — Progressive spinal muscle atrophy, G12.29 — Other motor neuron disease, +117 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Spinal Cord Disorders/Injuries) for risk-adjusted payment.

B00.82 — Herpes simplex myelitis, B01.12 — Varicella myelitis, B02.24 — Postherpetic myelitis, G04.82 — Acute flaccid myelitis, G04.89 — Other myelitis, G04.91 — Myelitis, unspecified, G05.4 — Myelitis in diseases classified elsewhere, G14 — Postpolio syndrome, G32.0 — Subacute combined degeneration of spinal cord in diseases classified elsewhere, G32.81 — Cerebellar ataxia in diseases classified elsewhere, G37.3 — Acute transverse myelitis in demyelinating disease of central nervous system, G37.4 — Subacute necrotizing myelitis of central nervous system, G83.4 — Cauda equina syndrome, G90.1 — Familial dysautonomia [Riley-Day], G95.0 — Syringomyelia and syringobulbia, G95.11 — Acute infarction of spinal cord (embolic) (nonembolic), G95.19 — Other vascular myelopathies, G95.20 — Unspecified cord compression, G95.29 — Other cord compression, G95.81 — Conus medullaris syndrome, +230 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Quadriplegia, Paraplegia

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Paralysis (other than cerebral palsy)).

G81.00 — Flaccid hemiplegia affecting unspecified side, G81.01 — Flaccid hemiplegia affecting right dominant side, G81.02 — Flaccid hemiplegia affecting left dominant side, G81.03 — Flaccid hemiplegia affecting right nondominant side, G81.04 — Flaccid hemiplegia affecting left nondominant side, G81.10 — Spastic hemiplegia affecting unspecified side, G81.11 — Spastic hemiplegia affecting right dominant side, G81.12 — Spastic hemiplegia affecting left dominant side, G81.13 — Spastic hemiplegia affecting right nondominant side, G81.14 — Spastic hemiplegia affecting left nondominant side, G81.90 — Hemiplegia, unspecified affecting unspecified side, G81.91 — Hemiplegia, unspecified affecting right dominant side, G81.92 — Hemiplegia, unspecified affecting left dominant side, G81.93 — Hemiplegia, unspecified affecting right nondominant side, G81.94 — Hemiplegia, unspecified affecting left nondominant side, G82.20 — Paraplegia, unspecified, G82.21 — Paraplegia, complete, G82.22 — Paraplegia, incomplete, G82.50 — Quadriplegia, unspecified, G82.51 — Quadriplegia, C1-C4 complete, +27 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Paraplegia”; these codes share that main term but sit in a different category of the Tabular List.

A18.01 — Tuberculosis of spine (Pott's), A52.17 — General paresis (syphilitic), F44.4 — Conversion disorder with motor symptom or deficit (hysterical), G11.4 — Hereditary spastic paraplegia (familial spastic), G80.1 — Spastic diplegic cerebral palsy (congenital, spastic), G80.8 — Other cerebral palsy (congenital), G82.20 — Paraplegia, unspecified, G82.21 — Paraplegia, complete (complete), G82.22 — Paraplegia, incomplete (incomplete)

Contextual Map

Every relationship of G04.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run G04.1 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 182 — Spinal Cord Disorders/Injuries [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
  • DRG 052 — SPINAL DISORDERS AND INJURIES WITH CC/MCC[MS-DRG]: “SPINAL DISORDERS AND INJURIES WITH CC/MCC (MDC 01)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
  • DRG 053 — SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC[MS-DRG]: “SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC (MDC 01)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 01 — Diseases and Disorders of the Nervous System[MDC crossing]: “Diseases and Disorders of the Nervous System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 8,892 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Paraplegia (lower), spastic, tropical[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Paraplegia (lower), tropical spastic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (18)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "G04.1 — Tropical spastic paraplegia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/g04.1-tropical-spastic-paraplegia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Tropical spastic paraplegia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to G04.1 in its code family, with their registry titles.

View all codes in the G04 family