G97.1 — Other reaction to spinal and lumbar puncture
G97.1 is a billable, specific ICD-10-CM code for other reaction to spinal and lumbar puncture. It is valid for submission on a claim.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- , if applicable, any associated headache with orthostatic component (R51.0)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Headache due to lumbar puncture
- Other reaction to spinal dural puncture
Risk adjustment
G97.1 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
G97.1 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 G97.1 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 G97.1.
- Complication›lumbar puncture
- Complication›puncture, spinal
- Headache›lumbar puncture
- Headache›postspinal puncture
- Headache›spinal fluid loss(from puncture)
- Reaction›fluid loss, cerebrospinal
- Reaction›lumbar puncture
- Reaction›spinal puncture
- Syncope›due to spinal puncture(lumbar)
- Complication›lumbar puncture›headache or reaction
- Complication›postoperative›lumbar puncture
- Complication›puncture, spinal›headache or reaction
Related codes at this level
Codes that share G97. If G97.1 is not quite right, the correct code is usually one of these.
- G97.0Cerebrospinal fluid leak from spinal puncture
- G97.2Intracranial hypotension following ventricular shunting
- G97.3Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a procedure
- G97.4Accidental puncture and laceration of a nervous system organ or structure during a procedure
- G97.5Postprocedural hemorrhage of a nervous system organ or structure following a procedure
- G97.6Postprocedural hematoma and seroma of a nervous system organ or structure following a procedure
- G97.8Other intraoperative and postprocedural complications and disorders of nervous system
Questions about G97.1
- Is G97.1 a billable ICD-10-CM code?
- Yes. G97.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does G97.1 sit in the tabular list?
- Diseases of the nervous system (G00-G99), in the block Other disorders of the nervous system (G89-G99).