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v1.0.0
ICD-10 Guide
ICD-10 CodesG96.1

G96.1

Billable

Disorders of meninges, not elsewhere classified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G96.1 is a billable code used to indicate a diagnosis of disorders of meninges, not elsewhere classified.

Key Diagnostic Point:

Disorders of the meninges encompass a variety of conditions that affect the protective membranes surrounding the brain and spinal cord. These disorders can manifest as pain syndromes, such as meningitis-related headaches, or as autonomic dysfunctions that may lead to symptoms like orthostatic hypotension or abnormal heart rates. Hydrocephalus, characterized by an accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, is another significant condition that falls under this classification. Patients may present with increased intracranial pressure, cognitive impairments, or gait disturbances. Other nervous system disorders associated with meninges may include arachnoiditis, which can cause chronic pain and neurological deficits. Accurate diagnosis often requires imaging studies, lumbar punctures, and a thorough clinical evaluation to differentiate these conditions from other neurological disorders. The complexity of these disorders necessitates a comprehensive understanding of the underlying pathophysiology and the clinical implications of each condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of symptoms that can overlap with other neurological conditions
  • Need for differential diagnosis to rule out other meningitis types
  • Potential for co-morbid conditions affecting coding accuracy
  • Variability in clinical presentation among patients

Audit Risk Factors

  • Inadequate documentation of symptoms and clinical findings
  • Misclassification of similar neurological disorders
  • Failure to document diagnostic tests performed
  • Inconsistent use of terminology in clinical notes

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed clinical notes including symptom descriptions, diagnostic tests, and treatment plans.

Common Clinical Scenarios

Patients presenting with headaches, cognitive changes, or signs of increased intracranial pressure.

Billing Considerations

Neurologists should ensure that all relevant diagnostic criteria and imaging results are documented to support the diagnosis.

Neurosurgery

Documentation Requirements

Operative reports, pre-operative assessments, and post-operative follow-ups.

Common Clinical Scenarios

Patients undergoing procedures for hydrocephalus or other meningeal disorders.

Billing Considerations

Neurosurgeons must document the rationale for surgical intervention and any complications that arise.

Coding Guidelines

Inclusion Criteria

Use G96.1 When
  • According to ICD
  • 10 coding guidelines, G96
  • 1 should be used when the specific disorder of the meninges does not fit into other defined categories
  • Coders must ensure that the documentation supports the diagnosis and that all relevant symptoms and tests are recorded

Exclusion Criteria

Do NOT use G96.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

62270CPT Code

Lumbar puncture

Clinical Scenario

Used to obtain cerebrospinal fluid for analysis in suspected meningitis cases.

Documentation Requirements

Document indication for the procedure, findings, and any complications.

Specialty Considerations

Neurologists and emergency physicians should ensure that the necessity of the procedure is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more precise coding of disorders of the meninges, enabling better tracking of these conditions and their outcomes. It has also increased the need for detailed documentation to support the use of G96.1.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more precise coding of disorders of the meninges, enabling better tracking of these conditions and their outcomes. It has also increased the need for detailed documentation to support the use of G96.1.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more precise coding of disorders of the meninges, enabling better tracking of these conditions and their outcomes. It has also increased the need for detailed documentation to support the use of G96.1.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common symptoms associated with disorders of the meninges?

Common symptoms include severe headaches, nausea, vomiting, photophobia, cognitive changes, and signs of increased intracranial pressure such as altered consciousness or gait disturbances.

How do I differentiate G96.1 from other meningitis codes?

G96.1 should be used when the specific type of meningitis is not identified. If the type is known, use the appropriate code from G00-G09.