G96.11 — Dural tear
G96.11 is a billable, specific ICD-10-CM code for dural tear. It is valid for submission on a claim.
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
G96.11 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
G96.11 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56612Billing and Coding: CT of the Head
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
- A57206Billing and Coding: Lumbar MRI
How G96.11 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to G96.11.
- Tear, torn›dural›nontraumatic
Related codes at this level
Codes that share G96.1. If G96.11 is not quite right, the correct code is usually one of these.
Questions about G96.11
- Is G96.11 a billable ICD-10-CM code?
- Yes. G96.11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does G96.11 sit in the tabular list?
- Diseases of the nervous system (G00-G99), in the block Other disorders of the nervous system (G89-G99).
- What cannot be coded together with G96.11?
- G96.11 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.