I96 ICD-10-CM Code: Gangrene, not elsewhere classified
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
RAF 1.118
CMS-HCC V24
MappedHCC 106
RAF 1.488
ACA/HHS
MappedHCC 153
Varies by metal level
ESRD/PACE
MappedHCC 106
RAF 0.358
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Gangrenous cellulitis
Excludes 2
Official- gangrene in diabetes mellitus (E08-E13 with .52)
Related Child Codes
ICD-10-CM does not list child codes under I96 for this display context.
Includes
OfficialICD-10-CM does not list Includes notes for I96 in this effective period.
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)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I96 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I96 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I96 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 I96 an HCC code?
Yes. I96 maps to Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene under the CMS-HCC V28 risk adjustment model (and Atherosclerosis of the Extremities with Ulceration or Gangrene under V24).
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work I96 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I96
For I96to 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 I96 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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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 community, non-dual, aged base RAF weight of 1.118. Under the older CMS-HCC V24 model, I96 maps to Atherosclerosis of the Extremities with Ulceration or Gangrene (HCC 106) with a community, non-dual, aged base RAF weight of 1.488. 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 the anatomical site of gangrene with an additional code when possible. Because I96 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 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