I96: Gangrene, not elsewhere classified
I96 is a billable, specific ICD-10-CM code for gangrene, not elsewhere classified. It is valid for submission on a claim.
Check I96 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- gangrene in atherosclerosis of native arteries of the extremities (I70.26)
- gangrene in hernia (K40.1, K40.4, K41.1, K41.4, K42.1, K43.1-, K44.1, K45.1, K46.1)
- gangrene in other peripheral vascular diseases (I73.-)
- gangrene of certain specified sites - see Alphabetical Index
- gas gangrene (A48.0)
- pyoderma gangrenosum (L88)
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Gangrenous cellulitis
Risk adjustment
I96 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 263 Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene1.118 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
I96 is named in 25 Medicare coverage policies: 25 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52998Billing and Coding: Surgical Treatment of Nails
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
Alphabetic index entries that lead here
- Acrosphacelus
- Gangrene, gangrenous(connective tissue) (dropsical) (dry) (moist) (skin) (ulcer)
- Gangrene, gangrenous›abdomen(wall)
- Gangrene, gangrenous›auricle
- Gangrene, gangrenous›cutaneous, spreading
- Gangrene, gangrenous›extremity(lower) (upper)
- Gangrene, gangrenous›limb(lower) (upper)
- Gangrene, gangrenous›perineum
- Gangrene, gangrenous›spine
- Gangrene, gangrenous›spreading cutaneous
- Gangrene, gangrenous›umbilicus
- Necrosis, necrotic›skin or subcutaneous tissue NEC
Code history
Unchanged in every release from FY2024 to FY2027.