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I96 ICD-10-CM Code: Gangrene, not elsewhere classified

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 6 Excludes1 · 1 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 106

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 299 — PERIPHERAL VASCULAR DISORDERS WITH MCC (MDC 05)
  • MS-DRG 300 — PERIPHERAL VASCULAR DISORDERS WITH CC (MDC 05)
  • MS-DRG 301 — PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC (MDC 05)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 263 — Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene (supersedes HCC 264, HCC 383, HCC 409)

Other models: CMS-HCC V22 HCC 106

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I96 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Gangrenous cellulitis

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for I96

MedCoder structured workflow — derived from this code’s own official record

Before you code I96

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on I96; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I96. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in I96’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewI70.26, K40.1, K40.4, K41.1, K41.4, K42.1

Consider I96. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting I96(6 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I96: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI70.26, K40.1, K40.4, K41.1, K41.4, K42.1

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of I96(1 note)

    Coding workflow: The conditions named in this note are not included in I96. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition I96 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewI70.26, K40.1, K40.4, K41.1, K41.4, K42.1

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Gangrene, not elsewhere classified is a billable ICD-10-CM diagnosis code (I96).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (13)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name I96 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes2 notes: L98.4 — Non-pressure chronic ulcer of skin, not elsewhere classified, L98.A — Non-pressure chronic ulcer of upper limb, not elsewhere classified.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Code First instructions: L89 — Pressure ulcer, L97 — Non-pressure chronic ulcer of lower limb, not elsewhere classified.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 45 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 299 (MDC 05), DRG 300 (MDC 05), DRG 301 (MDC 05), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR028 — Gangrene (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

G89.22 — Chronic post-thoracotomy pain, G89.28 — Other chronic postprocedural pain, G89.29 — Other chronic pain, G89.3 — Neoplasm related pain (acute) (chronic), G89.4 — Chronic pain syndrome, I70.261 — Atherosclerosis of native arteries of extremities with gangrene, right leg, I70.262 — Atherosclerosis of native arteries of extremities with gangrene, left leg, I70.263 — Atherosclerosis of native arteries of extremities with gangrene, bilateral legs, I70.268 — Atherosclerosis of native arteries of extremities with gangrene, other extremity, I70.269 — Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity, R41.0 — Disorientation, unspecified, R41.1 — Anterograde amnesia, R41.2 — Retrograde amnesia, R41.3 — Other amnesia, R41.82 — Altered mental status, unspecified, R41.9 — Unspecified symptoms and signs involving cognitive functions and awareness, R44.8 — Other symptoms and signs involving general sensations and perceptions, R44.9 — Unspecified symptoms and signs involving general sensations and perceptions, R45.83 — Excessive crying of child, adolescent or adult, R45.84 — Anhedonia, +24 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) for risk-adjusted payment.

I70.732 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf, I70.733 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle, I70.734 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot, I70.735 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot, I70.738 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg, I70.739 — Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of unspecified site, I70.741 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh, I70.742 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf, I70.743 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle, I70.744 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot, I70.745 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot, I70.748 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg, I70.749 — Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of unspecified site, I70.75 — Atherosclerosis of other type of bypass graft(s) of other extremity with ulceration, I70.761 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg, I70.762 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg, I70.763 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs, I70.768 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, other extremity, I70.769 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, unspecified extremity, I73.01 — Raynaud's syndrome with gangrene, +106 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Vascular Disease with Complications, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle, Amputation Status, Lower Limb/Amputation Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Gangrene).

I70.662 — Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg, I70.663 — Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs, I70.668 — Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, other extremity, I70.669 — Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, unspecified extremity, I70.761 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg, I70.762 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg, I70.763 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs, I70.768 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, other extremity, I70.769 — Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, unspecified extremity, I73.01 — Raynaud's syndrome with gangrene, J85.0 — Gangrene and necrosis of lung, K40.10 — Bilateral inguinal hernia, with gangrene, not specified as recurrent, K40.11 — Bilateral inguinal hernia, with gangrene, recurrent, K40.40 — Unilateral inguinal hernia, with gangrene, not specified as recurrent, K40.41 — Unilateral inguinal hernia, with gangrene, recurrent, K41.10 — Bilateral femoral hernia, with gangrene, not specified as recurrent, K41.11 — Bilateral femoral hernia, with gangrene, recurrent, K41.40 — Unilateral femoral hernia, with gangrene, not specified as recurrent, K41.41 — Unilateral femoral hernia, with gangrene, recurrent, K42.1 — Umbilical hernia with gangrene, +34 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Necrosis, necrotic”, “Gangrene, gangrenous”, “Noma”; these codes share that main term but sit in a different category of the Tabular List.

G95.19 — Other vascular myelopathies (spine, spinal, cord), H15.89 — Other disorders of sclera (sclera), H18.89 — Other specified disorders of cornea (cornea), I21.4 — Non-ST elevation (NSTEMI) myocardial infarction (subendocardial), I25.89 — Other forms of chronic ischemic heart disease (subendocardial, chronic), I67.89 — Other cerebrovascular disease (brain), I73.01 — Raynaud's syndrome with gangrene (Raynaud's), I73.1 — Thromboangiitis obliterans [Buerger's disease] (presenile), I77.5 — Necrosis of artery (artery), I89.1 — Lymphangitis (lymphangitis), J02.9 — Acute pharyngitis, unspecified (pharynx), J04.0 — Acute laryngitis (laryngitis), J32.0 — Chronic maxillary sinusitis (antrum), J32.2 — Chronic ethmoidal sinusitis (ethmoid), J34.0 — Abscess, furuncle and carbuncle of nose (nose), J35.8 — Other chronic diseases of tonsils and adenoids (tonsil), J36 — Peritonsillar abscess (quinsy), J38.7 — Other diseases of larynx (larynx), J39.2 — Other diseases of pharynx (retropharyngeal), J39.8 — Other specified diseases of upper respiratory tract (trachea), +60 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of I96 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I96 with these 17 related codes in Claim Check

Hierarchy

Excludes1 (13)

Excludes2

Referenced by Excludes2 notes

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 263 — Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene [CMS-HCC]: “Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene — supersedes HCC 264 (Vascular Disease with Complications), HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle), HCC 409 (Amputation Status, Lower Limb/Amputation Complications)”— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 05 — Diseases and Disorders of the Circulatory System[MDC crossing]: “Diseases and Disorders of the Circulatory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 17,209 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (13)

  • Acrosphacelus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), abdomen (wall)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), auricle[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), cutaneous, spreading[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), extremity (lower) (upper)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), limb (lower) (upper)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Gangrene, gangrenous (connective tissue) (dropsical) (dry) (moist) (skin) (ulcer), perineum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • and 5 more

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Gangrene, not elsewhere classified

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.