I96 ICD-10-CM Code: Gangrene, not elsewhere classified
I96 maps to CMS-HCC V28 263. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other and unspecified disorders of the circulatory system (I95-I99)
I96
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGangrene, not elsewhere classified
Death and decay of body tissue due to loss of blood supply or severe infection, not classified under other specific conditions.
Buddy Insight
Gangrene not elsewhere classified represents tissue death due to inadequate blood supply or severe infection, a critical condition that often requires urgent surgical intervention including possible amputation.
CMS-HCC V28
MappedHCC 263
Coefficient HCC 263: 1.118 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 153
Code-level coefficient reference
ESRD/PACE
MappedHCC 106
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Gangrenous cellulitis
Excludes 2
Official- gangrene in diabetes mellitus (E08-E13 with .52)
- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99
- neoplasms (C00-D49)Inherited from I00-I99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99
Related Codes
No related codes are included in this display for I96. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for I96. Check the code and parent instructions in the Code Book.
Excludes 1
Official- 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)
Code First
OfficialNo Code First sequencing instructions are included in this display for I96. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for I96. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for I96. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is I96 an HCC code?
Yes. I96 (Gangrene, not elsewhere classified) maps to HCC 263, Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.118. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: I96 is billable and maps to V28 HCC 263, Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I96
- Description
- Gangrene, not elsewhere classified
- HCC (V28)
- HCC 263 — Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene
- RAF reference coefficient
- 1.118
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work I96 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I96
For I96, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
I96 is the ICD-10-CM diagnosis code for gangrene, not elsewhere classified. Death and decay of body tissue due to loss of blood supply or severe infection, not classified under other specific conditions. I96 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering other and unspecified disorders of the circulatory system (i95-i99).
Under the CMS-HCC V28 risk adjustment model, I96 maps to Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene (HCC 263) with a source-labeled community, non-dual, aged reference coefficient of 1.118. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Specify the anatomical site of gangrene with an additional code when possible. For I96, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for I96 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify the anatomical site of gangrene with an additional code when possible
- •Investigate whether the gangrene is due to diabetes, atherosclerosis, or other underlying conditions
Clinical Significance
Gangrene not elsewhere classified represents tissue death due to inadequate blood supply or severe infection, a critical condition that often requires urgent surgical intervention including possible amputation. This diagnosis indicates severe end-organ damage and carries high mortality and morbidity risk. It is a major driver of healthcare resource utilization due to surgical costs, prolonged hospitalization, wound care, rehabilitation, and prosthetic needs.
Documentation Requirements
- ✓Explicit documentation of gangrene (dry, wet, or gas gangrene type when specified)
- ✓Anatomical site of gangrenous tissue identified
- ✓Underlying etiology documented (peripheral vascular disease, diabetes, infection, trauma)
- ✓Extent of tissue involvement described
- ✓Vascular assessment findings (pulses, perfusion status, imaging results)
- ✓Treatment plan including surgical intervention, debridement, or amputation if applicable
- ✓Assessment of viability of surrounding tissue
Excludes 1, Do NOT code together
- 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)
Commonly Confused Codes
- •E11.52: Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene; use when gangrene is directly attributable to diabetes
- •I70.261/I70.262: Atherosclerosis of native arteries of extremities with gangrene; use when gangrene is due to peripheral artery disease
- •A48.0: Gas gangrene; use specifically for clostridial gas gangrene infection
- •R02: This code was deleted and replaced by I96; do not use R02
- •L03.xxx: Cellulitis codes; cellulitis is infection without tissue death and should not be confused with gangrene
- •T79.A: Traumatic compartment syndrome; may lead to gangrene but is coded separately