G96.11

G96.11: Dural tear

Billable / specific codeICD-10-CM

G96.11 is a billable, specific ICD-10-CM code for dural tear. It is valid for submission on a claim.

Check G96.11 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

accidental puncture or laceration of dura during a procedure (G97.41)

Code also

Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.

intracranial hypotension, if applicable (G96.81-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

G96.11 is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56612Billing and Coding: CT of the Head
A57204Billing and Coding: MRI and CT Scans of the Head and Neck
A57206Billing and Coding: Lumbar MRI

Alphabetic index entries that lead here

Tear, torn›dural›nontraumatic

Code history

Unchanged in every release from FY2024 to FY2027.