ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 G07

Billable / Specific MCC

Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere

G07
Block
0
Synonyms
38
LCDs
3
Payer Policies
5
Linked CPTs

About ICD-10-CM G07

ICD-10-CM code G07 represents Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere. This is a billable/specific code in the Nervous System chapter (block G07). The 2026 edition of ICD-10-CM G07 became effective on October 1, 2025.

Coding Tips for G07

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: MCC

G07 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Type 1 Excludes

Pure excludes, these codes can never be coded together with G07. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • abscess of brain:
  • amebic (A06.6)
  • chromomycotic (B43.1)
  • gonococcal (A54.82)
  • tuberculous (A17.81)
  • tuberculoma of meninges (A17.1)

Coding Notes

Code First

  • underlying disease, such as:
  • schistosomiasis granuloma of brain (B65.-)

Inpatient DRG Impact, MCC

codes Intracranial and intraspinal abscess and granuloma in diseases classified elsewhere. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.

Medicare LCD Coverage for G07

Local Coverage Determinations (LCDs) from CMS MACs that list G07 as a covered diagnosis.

38 LCDs

Showing top 10 of 38 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Lumbar MRI
Article ID: 57206, Effective: 2025-10-23 00:00:00, 3361 covered, 0 non-covered
CPT Q9953 →
CMS LCD: Billing and Coding: Lumbar MRI
Article ID: 57206, Effective: 2025-10-23 00:00:00, 3361 covered, 0 non-covered
CPT 72148 →
CMS LCD: Billing and Coding: Lumbar MRI
Article ID: 57206, Effective: 2025-10-23 00:00:00, 3361 covered, 0 non-covered
CPT A9585 →
CMS LCD: Billing and Coding: Lumbar MRI
Article ID: 57206, Effective: 2025-10-23 00:00:00, 3361 covered, 0 non-covered
CPT 72158 →
CMS LCD: Billing and Coding: Lumbar MRI
Article ID: 57206, Effective: 2025-10-23 00:00:00, 3361 covered, 0 non-covered
CPT 72149 →
CMS LCD: Billing and Coding: Lumbar Spinal Fusion
Article ID: 56396, Effective: 2023-01-01 00:00:00, 308 covered, 0 non-covered
CPT 22612 →
CMS LCD: Billing and Coding: Lumbar Spinal Fusion
Article ID: 56396, Effective: 2023-01-01 00:00:00, 308 covered, 0 non-covered
CPT 22558 →
CMS LCD: Billing and Coding: Lumbar Spinal Fusion
Article ID: 56396, Effective: 2023-01-01 00:00:00, 308 covered, 0 non-covered
CPT 22633 →
CMS LCD: Billing and Coding: Lumbar Spinal Fusion
Article ID: 56396, Effective: 2023-01-01 00:00:00, 308 covered, 0 non-covered
CPT 22630 →
CMS LCD: Billing and Coding: Lumbar Spinal Fusion
Article ID: 56396, Effective: 2023-01-01 00:00:00, 308 covered, 0 non-covered
CPT 22533 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing G07.

3 policies

3 Medicare

Billing and Coding: Lumbar Spinal Fusion
Policy ID: ART-56396
Billing and Coding: MRI and CT Scans of the Head and Neck
Policy ID: ART-57204
Billing and Coding: Lumbar MRI
Policy ID: ART-57206

CPT Codes Commonly Billed with G07

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

5 linkages
  • 22630 CMS LCD: Billing and Coding: Lumbar Spinal Fusion CMS LCD
  • 22533 CMS LCD: Billing and Coding: Lumbar Spinal Fusion CMS LCD
  • 22612 CMS LCD: Billing and Coding: Lumbar Spinal Fusion CMS LCD
  • 22558 CMS LCD: Billing and Coding: Lumbar Spinal Fusion CMS LCD
  • 22633 CMS LCD: Billing and Coding: Lumbar Spinal Fusion CMS LCD

Convert G07 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
G07 3249 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 G07, Billing FAQ

Is ICD-10 code G07 billable? +

Yes, G07 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for G07? +

Type 1 Excludes (never code together with G07): abscess of brain:; amebic (A06.6); chromomycotic (B43.1)

Is G07 a CC or MCC for inpatient DRG? +

Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What CPT codes are commonly billed with G07? +

Procedures frequently paired with G07 include: 22630, 22533, 22612, 22558, 22633.

What ICD-9 codes does G07 map to? +

Per CMS GEMs, G07 maps to ICD-9 codes: 3249. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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