Crystal's MCW Coder Hub🧬 ICD-10 CM G95.11 - Acute Infarction of Spinal Cord (Embolic)(Nonembolic)
Quick reference
| Element | Value |
|---|---|
| ICD-10-CM code | G95.11 |
| Official descriptor | Acute infarction of spinal cord (embolic)(nonembolic) |
| Inclusion terms | Anoxia of spinal cord; Arterial thrombosis of spinal cord |
| Synonym | Spinal cord stroke; anterior spinal artery syndrome; spinal cord infarction |
| Parent category | G95.1- - Vascular myelopathies; G95 - Other and unspecified diseases of spinal cord |
| ICD-10-CM chapter | G00-G99 (Diseases of the nervous system) → G89-G99 (Other disorders of the nervous system) |
| Billable | âś“ Yes (terminal, reportable code) |
| Clinical mechanism | Ischemic infarction of spinal cord tissue from arterial occlusion (embolic or thrombotic) or global hypoperfusion causing irreversible parenchymal necrosis |
| HCC status | YES — HCC-relevant in CMS-HCC models (verify current-year V28 mapping; spinal cord infarction maps as high-acuity neurological event with ongoing disability) |
| Chronic condition | Yes — residual myelopathy from spinal cord infarction is a chronic, permanent condition requiring ongoing management |
| Annual recapture required | YES — HCC codes must be recaptured annually for risk adjustment; resets each January |
Short description
ICD-10 CM G95.11 codes acute infarction of the spinal cord, whether from embolic or nonembolic (thrombotic, hypoperfusion) mechanisms. It is the spinal cord equivalent of an ischemic stroke — permanent neurological deficits result from irreversible ischemic necrosis of cord parenchyma. This is a high-acuity, HCC-relevant diagnosis with significant functional impact, typically presenting as acute-onset paraplegia or quadriplegia with autonomic dysfunction.
Tip
Use ICD-10 CM G95.11 for the acute phase of spinal cord infarction — the encounter at which the infarction is actively occurring or was just diagnosed. For sequelae (residual deficits after the acute phase has resolved), use G95.89 or a sequela code as appropriate. Also code the underlying vascular etiology (e.g., I65.-, I66.- for arterial occlusion, I70.- for atherosclerosis) and any functional deficits (paraplegia, paraparesis) separately. Query the provider regarding embolic vs. thrombotic mechanism when possible.
Full description (clinical context)
Pathophysiology of spinal cord infarction
The spinal cord receives its blood supply from a single anterior spinal artery (ASA) and paired posterior spinal arteries (PSA), both arising from the vertebral arteries, supplemented by radiculomedullary arteries (the largest of which is the artery of Adamkiewicz, typically arising from T9-T12 on the left).
Vascular territory and vulnerability:
- Anterior spinal artery supplies the anterior 2/3 of the cord (corticospinal tracts, spinothalamic tracts, anterior horn cells) — most commonly infarcted territory
- Posterior spinal arteries supply the dorsal columns (posterior 1/3) — less commonly affected
- The thoracic cord (T4-T8) is a watershed zone with the most tenuous blood supply — most vulnerable to ischemia
Mechanisms of spinal cord infarction:
- Embolic: Cardiac embolism, aortic atherosclerotic plaque embolism, fibrocartilaginous embolism (nucleus pulposus material), fat embolism
- Thrombotic/atherosclerotic: In situ thrombosis of spinal arteries or feeding radiculomedullary arteries; aortic dissection or repair interrupting flow to artery of Adamkiewicz
- Hypoperfusion/anoxic: Intraoperative hypotension (especially aortic surgery, cardiac surgery), cardiac arrest, severe systemic hypotension
- Vasospasm: Cocaine, ergotamines
- Iatrogenic: Aortic surgery (TAAA/TEVAR), aortic cross-clamping, spinal anesthesia complications
Fibrocartilaginous embolism (FCE):
- A unique and underrecognized mechanism — nucleus pulposus material enters the spinal arterial circulation, most often in young patients with minimal vascular risk factors
- Often preceded by minor trauma or Valsalva-type activity
- Rapid onset; MRI may be initially normal; DWI positive early
- Code G95.11 with external cause if FCE confirmed
Clinical presentation & symptoms
Onset: Classically sudden and maximal at onset — “thunderclap” back/neck pain followed immediately by weakness; alternatively, rapid progression over minutes to hours distinguishing from slower-evolving compressive myelopathy.
Anterior spinal artery syndrome (most common presentation):
- Bilateral motor loss: Immediate flaccid weakness (spinal shock) → evolves to spasticity/UMN pattern over days to weeks
- Bilateral pain/temperature loss below the level of infarction (spinothalamic tract)
- Preserved proprioception and vibration (dorsal columns spared — posterior spinal arteries intact)
- Autonomic dysfunction: Neurogenic bladder, bowel dysfunction, hypotension (loss of vasomotor tone)
- Quadriplegia/quadriparesis (cervical infarction) or paraplegia/paraparesis (thoracic infarction)
Posterior spinal artery syndrome (less common):
- Loss of proprioception, vibration, and light touch below lesion (dorsal columns)
- Relatively preserved motor function and pain/temperature sensation
Spinal shock phase (immediate):
- Flaccid paralysis, areflexia, urinary retention — lasts hours to days
- Followed by return of reflexes and evolution to UMN spasticity pattern
Brown-SĂ©quard variant (cord hemisection infarction):
- Ipsilateral motor and proprioception loss; contralateral pain/temperature loss
Diagnostic workup
MRI spine — essential for diagnosis:
- 72156 - MRI cervical spine with contrast (with and without for acute cord event)
- 72157 - MRI thoracic spine with contrast (thoracic cord most vulnerable)
- 72158 - MRI lumbar spine with contrast
- DWI (diffusion-weighted imaging): detects early infarction within hours (similar to brain DWI for stroke)
- T2 signal: “pencil-like” hyperintensity along cord length in anterior distribution; “owl eye” sign on axial cross-section (bilateral anterior horn involvement)
- Gadolinium enhancement may appear 24-72 hours post-infarction
Vascular imaging:
- 72198 - MRA lumbar spine with contrast
- 70549 - MRA head and neck with contrast: vertebral/carotid evaluation
- 75574 - CTA coronary arteries (if cardiac embolism suspected): aortic arch evaluation
- 93306 - Echocardiogram with Doppler: cardiac source of embolism
- 93312 - Transesophageal echocardiogram (TEE): aortic arch, patent foramen ovale evaluation
CT spine:
- 72125 - CT cervical spine without contrast: rule out hemorrhage, structural cause
- 72128 - CT thoracic spine without contrast
Electrophysiology:
- 95919 - SSEPs: monitoring cord function over time; prognostication
- 95926 - Short-latency SSEPs, lower limbs: thoracic/lumbar cord assessment
- 95860-95864 - Needle EMG: evaluate anterior horn cell involvement (lower motor neuron)
- 95908-95913 - NCS: peripheral nerve differentiation
Lab workup:
- Hypercoagulable panel (antiphospholipid, Factor V Leiden) for thrombotic etiology
- Lipid panel, HbA1c: vascular risk factors
- Blood cultures: if infectious vasculitis or embolic source suspected
Coding specifics (G95.11 vs. related codes)
Code structure breakdown
| Character position | Value | Meaning |
|---|---|---|
| 1st | G | Diseases of the nervous system |
| 2nd-3rd | 95 | Other and unspecified diseases of spinal cord |
| 4th | .1 | Vascular myelopathies |
| 5th | 1 | Acute infarction (embolic or nonembolic) |
When to code G95.11
Use G95.11 when:
- Provider documents acute spinal cord infarction, spinal cord stroke, anterior spinal artery infarction/occlusion, or arterial thrombosis of spinal cord
- Documentation supports ischemic mechanism (embolic or thrombotic) causing cord parenchymal necrosis
- Acute presentation: sudden onset neurological deficits with imaging confirmation
- Inclusion terms apply: anoxia of spinal cord, arterial thrombosis of spinal cord
Supporting documentation phrases:
- “Acute spinal cord infarction at T6, likely embolic.”
- “Anterior spinal artery syndrome, confirmed on MRI DWI.”
- “Spinal cord stroke, thoracic level, thrombotic mechanism.”
- “Arterial thrombosis of spinal cord — cord infarction.”
- “Anoxic spinal cord injury from intraoperative hypotension.”
- “Fibrocartilaginous embolism with cord infarction at C5-C6.”
Also code (when documented)
Per ICD-10-CM guidelines, code also any underlying cause:
- Aortic dissection → I71.0x
- Aortic atherosclerosis → I70.0
- Cardiac embolism → I48.91 (atrial fibrillation) + I63.-
- Hypercoagulable state → D68.61 or D68.69
- Cocaine use → F14.- + external cause
- Post-aortic surgery complication → T82.- or I97.8x
When NOT to use G95.11 — use a more specific or different code
| Condition documented | Correct code |
|---|---|
| Vascular myelopathy (other than acute infarction) | G95.19 |
| Hematomyelia (spinal cord hemorrhage) | G95.19 |
| Cord compression from vascular malformation | G95.20 or G95.29 |
| Non-ischemic myelopathy (drug, radiation, structural) | G95.89 |
| Traumatic spinal cord injury | S14.-, S24.-, S34.- |
| Acute myelitis (inflammatory) | G04.01, G04.02 |
| Cauda equina syndrome | G83.4 (not cord) |
Related ICD-10-CM codes (same family)
| ICD-10-CM | Description | When to use |
|---|---|---|
| G95.1- | Vascular myelopathies (category) | Non-billable parent — do not report |
| G95.11 | Acute infarction of spinal cord (embolic)(nonembolic) | THIS CODE — acute ischemic cord infarction |
| G95.19 | Other vascular myelopathies | Hematomyelia, edema, chronic ischemic, subacute necrotic |
| G95.20 | Unspecified cord compression | Compression, etiology not specified |
| G95.29 | Other cord compression | Specified compression, no more precise code |
| G95.81 | Conus medullaris syndrome | Conus-specific presentation |
| G95.89 | Other specified diseases of spinal cord | Drug/radiation myelopathy, tethered cord |
| G83.4 | Cauda equina syndrome | Below conus — not cord proper |
| I71.00 | Dissection of unspecified site of aorta | Aortic dissection as cause of cord infarction |
| I70.0 | Atherosclerosis of aorta | Atherosclerotic etiology |
| N31.9 | Neuromuscular dysfunction of bladder, unspecified | Neurogenic bladder — Excludes1, code separately |
| G82.20 | Paraplegia, unspecified | Functional deficit from cord infarction |
| G82.21 | Paraplegia, incomplete | Incomplete paraplegia — functional deficit |
| G82.22 | Paraplegia, complete | Complete paraplegia — functional deficit |
| G82.50 | Quadriplegia, unspecified | Cervical infarction functional deficit |
Excludes notes (from G95 category)
Excludes1 — Do NOT code G95.11 for:
- Neurogenic bladder NOS → N31.9 (code separately)
- Neurogenic bladder due to cauda equina syndrome → G83.4
- Neuromuscular dysfunction of bladder without spinal cord lesion → N31.-
Excludes2 (can code together when both documented):
- Myelitis → G04.-
HCC information (risk adjustment) — CRITICAL FOR CODING
HCC status: YES — G95.11 is HCC-relevant
ICD-10 CM G95.11 spinal cord infarction maps to HCC categories in CMS-HCC risk adjustment models given its high clinical severity, permanent disability implications, and ongoing resource utilization.
CMS-HCC Model evolution:
- V24 (through 2023): 86 HCC categories
- V28 (2024 model): 115 HCC categories (expanded); phased implementation
- Payment Year 2024: 67% V24 + 33% V28
- Payment Year 2025: 50% V24 + 50% V28
- Payment Year 2026: 33% V24 + 67% V28 (current blended year)
Why this matters for G95.11:
- Annual recapture required — HCC codes reset January 1st each year; document the ongoing myelopathy from spinal cord infarction at each applicable encounter annually
- RAF impact — Spinal cord infarction with resulting paraplegia/quadriplegia significantly increases predicted healthcare expenditure; accurate HCC capture is essential for MA plan risk adjustment
- Document functional status explicitly — paraplegia (G82.22), incomplete paraplegia (G82.21), or quadriplegia (G82.50) coded alongside G95.11 provides additional HCC specificity and supports RAF scoring
Best practice for HCC capture:
- Document “spinal cord infarction” explicitly at annual wellness visits and any major E/M encounter where the condition is addressed
- Include G95.11 on the active problem list with notation of functional status (paraplegia, neurogenic bladder)
- Pair with functional deficit codes (G82.2x, G82.5x) for complete clinical and risk picture
- Ensure coding is from a physician E/M encounter (not therapy-only visits) for HCC acceptance
Associated CPT codes (common pairings)
E/M codes
| CPT | Description | Context for G95.11 |
|---|---|---|
| 99221-99223 | Initial hospital care (low / moderate / high complexity) | Acute admission for spinal cord infarction |
| 99231-99233 | Subsequent hospital care (low / moderate / high complexity) | Ongoing inpatient management, neurology/rehab |
| 99291-99292 | Critical care, first 30-74 min; each add’l 30 min | High cervical cord infarction with respiratory failure |
| 99234-99236 | Observation/inpatient same-day admit/discharge | Short observation for cord infarction evaluation |
| 99202-99205 | New patient office visit | Initial outpatient consult for acute/subacute presentation |
| 99212-99215 | Established patient visit | Chronic myelopathy follow-up; HCC recapture visits |
Diagnostic imaging CPT codes
| CPT | Description | Clinical use |
|---|---|---|
| 72156 | MRI cervical spine with contrast | Cervical cord infarction — DWI, T2 evaluation |
| 72157 | MRI thoracic spine with contrast | Thoracic cord infarction — most common level |
| 72158 | MRI lumbar spine with contrast | Conus/lumbar cord infarction |
| 72141 | MRI cervical spine without contrast | Initial rapid evaluation |
| 72146 | MRI thoracic spine without contrast | Initial thoracic screening |
| 72125 | CT cervical spine without contrast | Hemorrhage exclusion; MRI contraindicated |
| 72128 | CT thoracic spine without contrast | Thoracic osseous and hemorrhage evaluation |
| 70549 | MRA head and neck with contrast | Vertebral/carotid artery evaluation |
| 72198 | MRA lumbar spine with contrast | Spinal vascular mapping |
| 75574 | CTA coronary arteries | Aortic arch/embolic source evaluation |
| 93306 | Echocardiogram with Doppler | Cardiac embolic source workup |
| 93312 | Transesophageal echocardiogram (TEE) | Aortic arch, PFO, cardiac source evaluation |
Electrophysiology CPT codes
| CPT | Description | Clinical use |
|---|---|---|
| 95919 | SSEPs | Cord function monitoring, prognostication |
| 95925 | Short-latency SSEPs, upper limbs | Cervical cord assessment |
| 95926 | Short-latency SSEPs, lower limbs | Thoracic/lumbar cord assessment |
| 95860 | Needle EMG, 1 extremity | Anterior horn cell / LMN involvement |
| 95861 | Needle EMG, 2 extremities | Bilateral evaluation |
| 95863 | Needle EMG, 3 extremities | Multilevel LMN evaluation |
| 95864 | Needle EMG, 4 extremities | Diffuse involvement |
| 95908 | NCS, 3-4 studies | Peripheral nerve differentiation |
| 95911 | NCS, 7-8 studies | Extended NCS |
| 95913 | NCS, 13+ studies | Comprehensive NCS evaluation |
Treatment CPT codes
| CPT | Description | Context for G95.11 |
|---|---|---|
| 96365-96368 | IV infusion, first hour + additional hours | IV anticoagulation (heparin), corticosteroids |
| 93503 | Pulmonary artery catheterization | Hemodynamic monitoring in acute severe cord infarction |
| 97110 | Therapeutic exercises | Inpatient/outpatient rehab — strength, mobility |
| 97530 | Therapeutic activities | ADL retraining post cord infarction |
| 97032 | Electrical stimulation, attended | Neuromuscular re-education |
| 97535 | Self-care/home management training | Independence training for paraplegic/quadriplegic patient |
| 97542 | Wheelchair management training | Mobility training for permanent paraplegia |
| 64550 | Application of surface neurostimulator | TENS for neuropathic pain management |
| 51702 | Insertion of temporary indwelling bladder catheter | Acute urinary retention — neurogenic bladder |
| 51700 | Bladder irrigation | Neurogenic bladder management |
Common modifiers
| Modifier | Description |
|---|---|
| -25 | Significant, separately identifiable E/M on same day as procedure |
| -59 | Distinct procedural service |
| -51 | Multiple procedures |
| -76 | Repeat procedure by same physician |
| -77 | Repeat procedure by another physician |
| -AI | Principal physician of record (inpatient admission E/M) |
| -GC | Service performed in part by resident under teaching physician supervision |
| -GE | Service performed by resident without presence of teaching physician |
| -KX | Requirements specified in medical policy have been met (therapy cap exception) |
| -GO | Services delivered under an outpatient occupational therapy plan of care |
| -GP | Services delivered under an outpatient physical therapy plan of care |
Sample ICD-10-CM combinations (work scenarios)
Scenario 1: Acute thoracic spinal cord infarction — embolic, inpatient admission
ICD-10-CM codes:
- G95.11 - Acute infarction of spinal cord (embolic)(nonembolic) (principal)
- I48.91 - Unspecified atrial fibrillation (underlying embolic source, if documented)
- G82.22 - Paraplegia, complete (functional deficit)
- N31.9 - Neuromuscular dysfunction of bladder, unspecified (neurogenic bladder — code separately)
CPT: 99223 - Initial hospital care, high complexity Modifier: -AI for admitting/principal physician of record
Rationale: G95.11 sequences as principal for the infarction; atrial fibrillation coded as the embolic source; functional deficit (G82.22) and neurogenic bladder (N31.9) coded separately. -y required for principal physician E/M on inpatient claim.
Scenario 2: Spinal cord infarction from aortic surgery complication
ICD-10-CM codes:
- G95.11 - Acute infarction of spinal cord (embolic)(nonembolic) (principal or secondary depending on admission reason)
- I97.820 - Intraoperative cerebrovascular infarction during cardiac surgery (complication code — verify specific T/I code for aortic surgical complication)
- I71.6 - Thoracoabdominal aortic aneurysm, without rupture (underlying diagnosis if TAAA repair was reason for surgery)
- G82.21 - Paraplegia, incomplete (functional deficit)
CPT: 99232 - Subsequent hospital care, moderate complexity (post-op day) Modifier: -AI for principal physician; -GC in teaching hospital
Rationale: Intraoperative cord infarction from aortic surgery is a known complication; both the complication code and G95.11 are required for complete coding. Functional deficit coded separately.
Scenario 3: Chronic residual myelopathy from prior spinal cord infarction — HCC annual recapture
ICD-10-CM codes:
- G95.11 - Acute infarction of spinal cord (HCC recapture — ongoing chronic sequela)
- G82.22 - Paraplegia, complete (permanent functional deficit)
- N31.9 - Neuromuscular dysfunction of bladder (neurogenic bladder, ongoing)
- Z87.39 - Personal history of other musculoskeletal disorders (if applicable — verify best history code)
CPT: 99214 - Established patient visit, moderate complexity Modifier: -25 if diagnostic study performed same day
Rationale: G95.11 coded annually for HCC recapture even in chronic/stable phase; the ongoing myelopathy and paraplegia are the residual manifestations justifying annual documentation. Neurogenic bladder and paraplegia coded alongside for complete clinical picture and maximum RAF accuracy.
Scenario 4: New outpatient neurology consult — suspected spinal cord infarction workup
ICD-10-CM codes:
- G95.11 - Acute infarction of spinal cord (if provider confirms diagnosis at consult)
- G82.21 - Paraplegia, incomplete (functional deficit)
- R20.2 - Paraesthesia of skin (if sensory symptoms documented prior to confirmed diagnosis)
CPT:
- 99205 - New patient visit, high complexity
- 72157 - MRI thoracic spine with contrast (ordered at visit)
- 95926 - Short-latency SSEPs, lower limbs (if performed)
Modifier: -25 on 99205 if E/M performed same day as diagnostic procedures
Rationale: -25 required when E/M and diagnostic studies are billed on the same date of service. If diagnosis not yet confirmed at time of visit, code the presenting signs/symptoms instead until confirmed by provider.
Documentation requirements (work checklist)
Essential elements for G95.11
-
Explicit diagnosis statement
- Provider must document “spinal cord infarction,” “spinal cord stroke,” “anterior spinal artery infarction,” or “arterial thrombosis of spinal cord” — imaging findings alone are insufficient; requires treating physician clinical diagnosis.
-
Embolic vs. nonembolic mechanism (query when unclear)
- G95.11 covers both embolic and nonembolic; however, documenting the specific mechanism (cardiac embolism, aortic atherosclerotic embolism, fibrocartilaginous embolism, thrombotic occlusion, hypoperfusion) allows coding of the underlying cause — important for complete HCC capture and sequencing accuracy.
-
Underlying etiology documented
- Aortic dissection, atrial fibrillation, aortic atherosclerosis, hypercoagulable state, procedural complication — each requires its own code per “code also” convention.
-
Level of cord involvement
- Cervical, thoracic, or lumbar level documented; impacts prognosis, rehabilitation planning, and supports imaging code selection.
-
Functional deficits explicitly stated
-
Autonomic/bladder/bowel dysfunction
-
Vascular risk factors
- Hypertension (I10), diabetes (E11.-), atrial fibrillation (I48.-), hyperlipidemia (E78.-) — all coded as comorbidities per standard guidelines.
-
Monitoring parameters (chronic phase)
- Spasticity management, pressure ulcer prevention, bladder management, rehabilitation progress — all support medical necessity for ongoing visits and HCC recapture.
Common auditor red flags
- G95.11 coded without underlying etiology → always code the precipitating vascular cause (aortic disease, cardiac embolism, procedural complication) per “code also” guidelines; missing etiology coding is a common audit deficiency.
- Functional deficits not coded → paraplegia and neurogenic bladder are separately reportable and HCC-impactful; omitting them understates clinical severity and reduces RAF accuracy.
- Neurogenic bladder bundled into G95.11 → per Excludes1, N31.9 must be coded separately.
- Traumatic spinal cord injury coded as G95.11 → traumatic cord injuries map to S14.-, S24.-, or S34.- by spinal level and type; G95.11 is for nontraumatic ischemic infarction only.
- Missing -AI modifier on inpatient admission E/M → required for principal physician identification on inpatient profee claims.
- HCC not recaptured annually → G95.11 with resultant paraplegia must be documented at least once per calendar year to maintain RAF score; most commonly missed at annual wellness visits.
Sample documentation (clinic/hospital note template)
Chief Complaint: Acute spinal cord infarction / myelopathy evaluation / cord infarction follow-up.
HPI: [Age]-year-old [male/female] with acute infarction of the spinal cord at the [cervical / thoracic / lumbar] level, [onset: date/time]. Patient presented with sudden onset [bilateral lower extremity weakness / quadriparesis / paraplegia], [pain/temperature loss below level], [preserved proprioception / loss of all modalities], and [urinary retention / bladder dysfunction]. [Embolic/thrombotic/hypoperfusion mechanism; underlying etiology: atrial fibrillation / aortic disease / peri-procedural / unknown].
Past Medical History:
- Acute spinal cord infarction at level — embolic / thrombotic / hypoperfusion] (diagnosed date)
- Atrial fibrillation / Aortic aneurysm / Aortic dissection / Hypercoagulable state — as applicable
- Other vascular risk factors: HTN, DM, hyperlipidemia
Current Medications:
- Anticoagulation: warfarin / DOAC / heparin infusion
- Antispastics: baclofen / tizanidine
- Neuropathic pain: gabapentin / pregabalin
- Bowel/bladder management regimen
Exam:
- Motor: Strength [0-5/5] bilateral lower extremities; flaccid / spastic tone; Babinski upgoing bilaterally
- Sensory: Loss of pain/temperature below dermatomal level]; preserved / absent vibration and proprioception
- Reflexes: Areflexia — acute phase / Hyperreflexia — chronic phase]; clonus present/absent
- Gait: Non-ambulatory / requires assistance / wheelchair dependent
- Bladder/Bowel: Urinary retention requiring catheterization / neurogenic bladder / neurogenic bowel
Assessment:
- Acute infarction of the spinal cord (embolic/nonembolic), cervical/thoracic/lumbar level — stable / improving / progressing]; complete / incomplete paraplegia / quadriplegia
- Underlying etiology: e.g., atrial fibrillation with cardioembolic mechanism / aortic atherosclerosis
- Neurogenic bladder, managed with indwelling catheter / intermittent catheterization
Plan:
- Anticoagulation / antithrombotic therapy per vascular etiology
- Inpatient rehabilitation referral for paraplegia management
- Neurogenic bladder management; urology referral
- Spasticity management: baclofen titration
- Annual follow-up for HCC documentation
ICD-10-CM:
- G95.11 - Acute infarction of spinal cord (embolic)(nonembolic)
- I48.91 - Atrial fibrillation / I71.00 - Aortic dissection — underlying etiology
- G82.22 - paraplegia, complete / G82.21 - paraplegia, incomplete
- N31.9 - Neurogenic bladder, if documented
CPT:
Billing & compliance pearls
- G95.11 is HCC-relevant — document at every applicable physician encounter annually, including annual wellness visits, to maintain RAF score; pairs best with functional deficit codes (G82.2x, G82.5x) for full HCC capture.
- Always code the underlying etiology — ICD-10-CM guidelines require coding the precipitating vascular cause (aortic dissection, cardiac embolism, atherosclerosis) alongside G95.11; missing etiology coding is a recurring audit finding.
- Code functional deficits separately — paraplegia (G82.22), incomplete paraplegia (G82.21), and quadriplegia (G82.50) are NOT included in G95.11; they must be coded as additional diagnoses to capture the full clinical picture and support HCC scoring.
- Neurogenic bladder is Excludes1 from G95 — always assign N31.9 separately; do not assume bladder dysfunction is bundled into the cord infarction code.
- Traumatic vs. nontraumatic distinction is critical — G95.11 is for nontraumatic ischemic cord infarction only; traumatic spinal cord injuries use S14.-, S24.-, or S34.-.
- Modifier -AI required for the admission E/M when billing as the principal physician of record on inpatient profee claims — one of the most commonly missed modifiers in inpatient profee.
- Modifier -25 required when a separately identifiable E/M service is performed on the same day as a diagnostic procedure (e.g., SSEPs, MRI ordered at the visit).
- Rehabilitation coding — when patient is admitted to inpatient rehab post cord infarction, G95.11 plus paraplegia code (G82.22) are the primary diagnoses supporting rehab admission medical necessity.