P11.5
P11.5: Birth injury to spine and spinal cord
Billable / specific codeICD-10-CM
P11.5 is a billable, specific ICD-10-CM code for birth injury to spine and spinal cord. It is valid for submission on a claim.
Check P11.5 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Fracture of spine due to birth injury
Risk adjustment
P11.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 182 Spinal Cord Disorders/Injuries0.478 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
P11.5 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56722Billing and Coding: Intraoperative Neurophysiological Testing
- A57041Billing and Coding: Somatosensory Testing
- A57206Billing and Coding: Lumbar MRI
- A57597Billing and Coding: Somatosensory Testing
Alphabetic index entries that lead here
- Hematomyelia›newborn(birth injury)
- Hematorachis, hematorrhachis›newborn(birth injury)
- Birth›injury NOS›spinal cord
- Birth›injury NOS›spine
- Dislocation›spine›due to birth trauma
- Fracture, traumatic›vertebra, vertebral›newborn(birth injury)
- Hematoma›spinal›newborn(birth injury)
- Hemorrhage, hemorrhagic›spinal›newborn(birth injury)
- Laceration›spinal cord›due to injury at birth
- Laceration›spinal cord›newborn(birth injury)
- Paralysis, paralytic›birth injury›spinal cord
- Rupture, ruptured›spinal cord›due to injury at birth
Code history
Unchanged in every release from FY2024 to FY2027.