What is ICD-10 code G95.11?

G95.11 is the ICD-10-CM diagnosis code for Acute infarction of spinal cord (embolic) (nonembolic). A sudden loss of blood flow to the spinal cord, either from a blood clot (embolic) or other causes (nonembolic), resulting in acute paralysis or loss of function. G95.11 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G95.11 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. G95.11 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. G95.11 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for G95.11?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For G95.11, V28 maps to Spinal Cord Disorders/Injuries at RAF 0.282 while V24 mapped to Spinal Cord Disorders/Injuries at RAF 0.464. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting G95.11?

Specify whether the infarction is embolic or nonembolic as indicated in the code Document the level of spinal cord involvement and any associated vascular disease Because G95.11 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

G95.11 ICD-10 Code: Acute infarction of spinal

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupG95.11Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Other disorders of the nervous system (G89-G99)

G95.11

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Acute infarction of spinal cord (embolic) (nonembolic)

A sudden loss of blood flow to the spinal cord, either from a blood clot (embolic) or other causes (nonembolic), resulting in acute paralysis or loss of function.

Buddy Insight

CMS-HCC V28

Mapped

HCC 182

Spinal Cord Disorders/Injuries

RAF 0.282

CMS-HCC V24

Mapped

HCC 72

Spinal Cord Disorders/Injuries

RAF 0.464

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 72

Spinal Cord Disorders/Injuries

RAF 0.0

RXHCC

Mapped

HCC 155

Myelitis and Encephalomyelitis

RAF 0.0

Code Trumping

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Code Book Path

Official

G95Other and unspecified diseases of spinal cord

G95.1Vascular myelopathies

G95.11Acute infarction of spinal cord (embolic) (nonembolic)

Inclusion Terms

Official

Anoxia of spinal cord
Arterial thrombosis of spinal cord

Excludes 2

Official

intraspinal phlebitis and thrombophlebitis, except non-pyogenic (G08)

Related Child Codes

Official

G95.19Other vascular myelopathies

Includes

Official

ICD-10-CM does not list Includes notes for G95.11 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G95.11 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G95.11 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G95.11 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G95.11 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Acute onset of neurological deficits with documentation of timing and progression

MRI of the spine demonstrating signal changes consistent with spinal cord infarction

Neurological examination documenting the level and extent of cord involvement

Vascular risk factor assessment and workup for embolic source when applicable

MEAT Support

HCC Buddy guidance

Acute onset of neurological deficits with documentation of timing and progression

MRI of the spine demonstrating signal changes consistent with spinal cord infarction

Neurological examination documenting the level and extent of cord involvement

Vascular risk factor assessment and workup for embolic source when applicable

Audit Caution

HCC Buddy guidance

Using generic spinal cord disease codes when acute infarction has been diagnosed

Confusing spinal cord infarction with cerebral infarction codes (I63 series)

Not documenting the acuity of onset, which distinguishes infarction from chronic vascular myelopathy

Failing to code associated permanent deficits (paraplegia, neurogenic bladder) separately when they persist

Common Mistakes

HCC Buddy guidance

G95.19 — Other vascular myelopathies: chronic or subacute vascular cord disease, not acute infarction

G95.20 — Unspecified cord compression: mechanical compression causing cord dysfunction, not vascular

G95.0 — Syringomyelia: chronic cavity formation in cord, not acute vascular event

I63.9 — Cerebral infarction, unspecified: brain infarction, not spinal cord

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is G95.11 an HCC code?

Yes. G95.11 maps to Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model (and Spinal Cord Disorders/Injuries under V24).

HCC Category Mapping

V28HCC 182, Spinal Cord Disorders/Injuries

0.282

V24HCC 72, Spinal Cord Disorders/Injuries

0.464

ESRDHCC 72, Spinal Cord Disorders/Injuries

0.000

RxHCCHCC 155, Myelitis and Encephalomyelitis

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for G95.11

For G95.11to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed G95.11 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

G95.11 is the ICD-10-CM diagnosis code for acute infarction of spinal cord (embolic) (nonembolic). A sudden loss of blood flow to the spinal cord, either from a blood clot (embolic) or other causes (nonembolic), resulting in acute paralysis or loss of function. G95.11 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering other disorders of the nervous system (g89-g99).

Under the CMS-HCC V28 risk adjustment model, G95.11 maps to Spinal Cord Disorders/Injuries (HCC 182) with a community, non-dual, aged base RAF weight of 0.282. Under the older V24 model, G95.11 mapped to the same category but with a base RAF weight of 0.464, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Specify whether the infarction is embolic or nonembolic as indicated in the code. Because G95.11 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G95.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Specify whether the infarction is embolic or nonembolic as indicated in the code
•Document the level of spinal cord involvement and any associated vascular disease

Clinical Significance

Acute infarction of the spinal cord is a vascular emergency resulting from sudden interruption of blood supply to the spinal cord, leading to rapid-onset neurological deficits including paralysis, sensory loss, and autonomic dysfunction. This is the spinal cord equivalent of a stroke and carries significant morbidity with potential for permanent disability. The acute nature and severity make it a high-resource diagnosis requiring urgent intervention and long-term rehabilitation.

Documentation Requirements

✓Acute onset of neurological deficits with documentation of timing and progression
✓MRI of the spine demonstrating signal changes consistent with spinal cord infarction
✓Neurological examination documenting the level and extent of cord involvement
✓Vascular risk factor assessment and workup for embolic source when applicable
✓Specification of embolic vs nonembolic mechanism when determined
✓Rehabilitation needs assessment and functional outcome goals

Commonly Confused Codes

•G95.19: Other vascular myelopathies: chronic or subacute vascular cord disease, not acute infarction
•G95.20: Unspecified cord compression: mechanical compression causing cord dysfunction, not vascular
•G95.0: Syringomyelia: chronic cavity formation in cord, not acute vascular event
•I63.9: Cerebral infarction, unspecified: brain infarction, not spinal cord