N49.3 ICD-10-CM Code: Fournier gangrene
N49.3 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the genitourinary system (N00-N99) / Diseases of male genital organs (N40-N53)
N49.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceFournier gangrene
A rapidly spreading, life-threatening bacterial infection of the genital area and surrounding tissues that causes tissue death.
Buddy Insight
Fournier gangrene is a urological emergency with high mortality risk, requiring immediate surgical debridement and aggressive antibiotic therapy.
CMS-HCC V28
MappedHCC 92
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 054
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for N49.3. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from N00-N99
- certain infectious and parasitic diseases (A00-B99)Inherited from N00-N99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from N00-N99
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from N00-N99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from N00-N99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from N00-N99
- neoplasms (C00-D49)Inherited from N00-N99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from N00-N99
Related Codes
Includes
OfficialNo Includes notes are included in this display for N49.3. Check the code and parent instructions in the Code Book.
Excludes 1
Official- inflammation of penis (N48.1, N48.2-)Inherited from N49
- orchitis and epididymitis (N45.-)Inherited from N49
Code First
OfficialNo Code First sequencing instructions are included in this display for N49.3. Check the code and parent instructions in the Code Book.
Use Additional
Official- code (B95-B97), to identify infectious agentInherited from N49
Code Also
OfficialNo Code Also instructions are included in this display for N49.3. 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 N49.3 an HCC code?
Yes. N49.3 (Fournier gangrene) maps to HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.479. 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: N49.3 is billable and maps to V28 HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- N49.3
- Description
- Fournier gangrene
- HCC (V28)
- HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- RAF reference coefficient
- 0.479
- 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 N49.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for N49.3
For N49.3, 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
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What This Code Means
N49.3 is the ICD-10-CM diagnosis code for fournier gangrene. A rapidly spreading, life-threatening bacterial infection of the genital area and surrounding tissues that causes tissue death. N49.3 sits in the ICD-10-CM chapter for diseases of the genitourinary system (n00-n99), within the section covering diseases of male genital organs (n40-n53).
Under the CMS-HCC V28 risk adjustment model, N49.3 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a source-labeled community, non-dual, aged reference coefficient of 0.479. No V24 mapping is shown for N49.3; use the applicable model and payment year when reviewing the V28 mapping. 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.
This is a medical emergency; ensure documentation reflects the severity and urgency of treatment. For N49.3, 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 N49.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a medical emergency; ensure documentation reflects the severity and urgency of treatment
- •Code the causative organism separately if identified (typically polymicrobial); this condition often requires sepsis coding as well
Clinical Significance
Fournier gangrene is a urological emergency with high mortality risk, requiring immediate surgical debridement and aggressive antibiotic therapy. This necrotizing fasciitis of the genitalia and perineum represents one of the most severe soft tissue infections, making accurate coding essential for risk adjustment.
Documentation Requirements
- ✓Clinical diagnosis of necrotizing fasciitis of male genitalia
- ✓Documentation of tissue necrosis and gangrene
- ✓Evidence of systemic toxicity or sepsis
- ✓Surgical debridement or intervention records
- ✓Microbiological culture results when available
- ✓Assessment of extent of tissue involvement
- ✓Treatment with broad-spectrum antibiotics
- ✓Monitoring for complications and organ dysfunction
Commonly Confused Codes
- •N76.82: Fournier disease of vagina and vulva (female genital involvement)
- •L03.314: Cellulitis of groin (superficial infection without necrosis)
- •N45.1: Epididymitis (localized testicular infection)
- •L08.9: Local skin and soft tissue infection, unspecified (non-necrotizing)
- •A49.9: Bacterial infection, unspecified (systemic infection without tissue necrosis)