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M95.12 ICD-10-CM Code: Cauliflower ear, left ear

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

Coding at a Glance

Tabular directives
7 Excludes2

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 154 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC (MDC 03)
  • MS-DRG 155 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC (MDC 03)
  • MS-DRG 156 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC (MDC 03)

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.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M95.12 in the official ICD-10-CM tabular list, quoted as published.

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

Notes without a marker are published on M95.12 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

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

Coder workflow for M95.12

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

Before you code M95.12

  1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: left). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

    ReviewM95.11 · right, M95.10 · unspecified

    Guide: Laterality coding →

Choose the right path

  1. Is the side documented?
    Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
    No → Use the unspecified-side code only when the record states no side; a query is the alternative.

    ReviewM95.11 · right, M95.10 · unspecified

Consider M95.12. 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).
Laterality
Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).

Official instructions as workflow

  • Excludes2 — not part of M95.12(7 notes)

    Coding workflow: The conditions named in this note are not included in M95.12. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareH61.1, M96

    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: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewM95.11 · right, M95.10 · unspecified

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

Cauliflower ear, left ear is a billable ICD-10-CM diagnosis code (M95.12).

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

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 M95.12 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 1 Excludes2 note: H61.1 — Noninfective disorders of pinna (via M95.1.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 3 MS-DRGs: DRG 154 (MDC 03), DRG 155 (MDC 03), DRG 156 (MDC 03).

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

Clinical classification (AHRQ CCSR):MUS023 — Acquired deformities (excluding foot) (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 condition, opposite side

Same category and title, differing only in which side of the body is affected.

M95.10 — Cauliflower ear, unspecified ear (unspecified)Compare M95.12 vs M95.10 →, M95.11 — Cauliflower ear, right ear (right)Compare M95.12 vs M95.11 →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Acquired deformities (excluding foot)).

M24.549 — Contracture, unspecified hand, M24.551 — Contracture, right hip, M24.552 — Contracture, left hip, M24.559 — Contracture, unspecified hip, M24.561 — Contracture, right knee, M24.562 — Contracture, left knee, M24.569 — Contracture, unspecified knee, M24.571 — Contracture, right ankle, M24.572 — Contracture, left ankle, M24.573 — Contracture, unspecified ankle, M24.59 — Contracture, other specified joint, M95.0 — Acquired deformity of nose, M95.10 — Cauliflower ear, unspecified ear, M95.11 — Cauliflower ear, right ear, M95.2 — Other acquired deformity of head, M95.3 — Acquired deformity of neck, M95.4 — Acquired deformity of chest and rib, M95.5 — Acquired deformity of pelvis, M95.8 — Other specified acquired deformities of musculoskeletal system, M95.9 — Acquired deformity of musculoskeletal system, unspecified, +124 more

Contextual Map

Every relationship of M95.12 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 M95.12 with this related code in Claim Check

Hierarchy

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — 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. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (11)

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
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

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M95.12 — Cauliflower ear, left ear." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/m95.12-cauliflower-ear-left-ear

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Cauliflower ear, left ear

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.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M95.12 in its code family, with their registry titles.

View all codes in the M95 family