M72.6

M72.6: Necrotizing fasciitis

Billable / specific codeICD-10-CM

M72.6 is a billable, specific ICD-10-CM code for necrotizing fasciitis. It is valid for submission on a claim.

Check M72.6 with the rest of the claim: free scrubber

Use additional code

Add a secondary code to capture the detail described below.

code (B95.-, B96.-) to identify causative organism

Excludes2 inherited from the categories above M72.6

Not part of this code, but both may be coded when both are present.

Written on M72: Fibroblastic disorders

retroperitoneal fibromatosis (D48.3)

Other codes that can never be billed with M72.6

Their own Excludes1 notes name this code, so the conflict is not listed above.

M72.8Other fibroblastic disorders

Risk adjustment

M72.6 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis0.479 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

M72.6 is named in 11 Medicare coverage policies: 4 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered