ICD-10 G96.11
Billable / Specific CCDural tear
About ICD-10-CM G96.11
ICD-10-CM code G96.11 represents Dural tear. This is a billable/specific code in the Nervous System chapter (block G96). The 2026 edition of ICD-10-CM G96.11 became effective on October 1, 2025.
Coding Tips for G96.11
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
G96.11 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC 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 G96.11. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- accidental puncture or laceration of dura during a procedure (G97.41)
Coding Notes
Code Also
- intracranial hypotension, if applicable (G96.81-)
Inpatient DRG Impact, CC
codes Dural tear. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for G96.11
Local Coverage Determinations (LCDs) from CMS MACs that list G96.11 as a covered diagnosis.
Showing top 10 of 45 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing G96.11.
1 Cigna
3 Medicare
CPT Codes Commonly Billed with G96.11
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert G96.11 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| G96.11 | 34939 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To G96.11
Other codes in section G89-G99 (Other disorders of the nervous system).
ICD-10 G96.11, Billing FAQ
Is ICD-10 code G96.11 billable? +
Yes, G96.11 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 G96.11? +
Type 1 Excludes (never code together with G96.11): accidental puncture or laceration of dura during a procedure (G97.41)
Is G96.11 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does G96.11 map to? +
Per CMS GEMs, G96.11 maps to ICD-9 codes: 34939. 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 May 31, 2026.
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