2026 ICD-10-CM Diagnosis Code G72.49Other inflammatory and immune myopathies, not elsewhere classified

ICD-10-CM Codes›G00–G99›G70-G73›G72

ICD-10-CM G72.49
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

G72.49 is a billable ICD-10-CM diagnosis code for other inflammatory and immune myopathies, not elsewhere classified. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 545 through 547. Coders also document this condition as autoimmune myopathy. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Myopathies.

G72.49 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the ESRD (V21) category 75 for payment year 2026.

Code Identity

ICD-10-CM Code
G72.49
Billable Status
Yes — Valid for Submission
Code Describes
Other inflammatory and immune myopathies, not elsewhere classified
Short Description
Oth inflammatory and immune myopathies, NEC
Parent Code
G72.4
Inflammatory and immune myopathies, not elsewhere classified

Code Classification

ChapterG00–G99Diseases of the nervous system
SectionG70-G73Diseases of myoneural junction and muscle
CategoryG72Other and unspecified myopathies
This CodeG72.49Other inflammatory and immune myopathies, not elsewhere classified

Medicare Risk Adjustment (HCC)Billing

G72.49 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
no payment category in the model that pays 100% of MA risk scores
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Other CMS Models
ESRD (V21): HCC 75
ESRD V21 weights: 0.059 dialysis, 0.284–0.323 functioning graft
Part D (RxHCC)
Not mapped
G72.49 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Autoimmune myopathy
  • Eosinophilic myopathy
  • Idiopathic inflammatory myopathy
  • Inflammatory myopathy with abundant macrophages
  • Muscle eosinophilia

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Inflammatory myopathy NOS

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR NVS018
Myopathies
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Muscle Disorders

Your muscles help you move and help your body work. Different types of muscles have different jobs. There are many problems that can affect muscles. Muscle disorders can cause weakness, pain or even paralysis.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert G72.49 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
359.79 Inflm/immune myopath NEC
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About G72.49Overview

What is the ICD-10 code for other inflammatory and immune myopathies, not elsewhere classified?

The ICD-10-CM code for other inflammatory and immune myopathies, not elsewhere classified is G72.49 (sometimes written as G7249). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is G72.49 (Inflammatory and immune myopathies, not elsewhere classified) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report other inflammatory and immune myopathies, not elsewhere classified on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does G72.49 group to?

When other inflammatory and immune myopathies, not elsewhere classified is the principal diagnosis on an inpatient stay, it groups to MS-DRG 545, 546, 547, with relative weights from 0.8362 to 2.4817 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of G72.49?

Under the General Equivalence Mappings, other inflammatory and immune myopathies, not elsewhere classified converts to ICD-9-CM 359.79 (inflm/immune myopath NEC). The mapping is approximate, so confirm the match fits the documentation.

Does G72.49 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage: G72.49 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the ESRD (V21) category 75 (Polyneuropathy).