ICD-10 I96
Billable / Specific HCC v28: 106 CCGangrene, not elsewhere classified
About ICD-10-CM I96
ICD-10-CM code I96 represents Gangrene, not elsewhere classified. This is a billable/specific code in the Circulatory System chapter (block I96). The 2026 edition of ICD-10-CM I96 became effective on October 1, 2025.
Coding Tips for I96
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I96 is a CMS-HCC v28 risk-adjustment code (category 106). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
I96 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I96. Per CMS ICD-10-CM Tabular 2026.
- Gangrenous cellulitis
Type 1 Excludes
Pure excludes, these codes can never be coded together with I96. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- 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)
Type 2 Excludes
Not included here, the excluded code is not part of I96, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- gangrene in diabetes mellitus (E08-E13 with .52)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Gangrene, not elsewhere classified. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I96
Local Coverage Determinations (LCDs) from CMS MACs that list I96 as a covered diagnosis.
Showing top 10 of 562 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I96.
1 Aetna
5 Medicare
CPT Codes Commonly Billed with I96
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert I96 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 |
|---|---|---|
| I96 | 7854 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I96
Other codes in section I95-I99 (Other and unspecified disorders of the circulatory system).
ICD-10 I96, Billing FAQ
Is ICD-10 code I96 billable? +
Yes, I96 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to I96? +
ICD-10 I96 includes: Gangrenous cellulitis.
What codes are Type 1 Excludes for I96? +
Type 1 Excludes (never code together with I96): 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.-)
What codes are Type 2 Excludes for I96? +
Type 2 Excludes (may be coded together when both conditions exist): gangrene in diabetes mellitus (E08-E13 with .52)
Does I96 affect Medicare Advantage HCC risk adjustment? +
Yes. I96 maps to CMS-HCC v28 category 106. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I96 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 CPT codes are commonly billed with I96? +
Procedures frequently paired with I96 include: 11732, 11765, 11750.
What ICD-9 codes does I96 map to? +
Per CMS GEMs, I96 maps to ICD-9 codes: 7854. 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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