Is P11.5 a billable ICD-10-CM code?

Yes. P11.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does P11.5 sit in the tabular list?

Certain conditions originating in the perinatal period (P00-P96), in the block Birth trauma (P10-P15).

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.

Inclusion 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.

Medicare coverage

P11.5 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56722Billing and Coding: Intraoperative Neurophysiological Testing
A57041Billing and Coding: Somatosensory Testing
A57206Billing and Coding: Lumbar MRI
A57597Billing and Coding: Somatosensory Testing

How P11.5 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to P11.5.

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

Related codes at this level

Codes that share P11. If P11.5 is not quite right, the correct code is usually one of these.

Questions about P11.5

Is P11.5 a billable ICD-10-CM code?: Yes. P11.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does P11.5 sit in the tabular list?: Certain conditions originating in the perinatal period (P00-P96), in the block Birth trauma (P10-P15).