Q05.4 — Unspecified spina bifida with hydrocephalus
Q05.4 is a billable, specific ICD-10-CM code for unspecified spina bifida with hydrocephalus. It is valid for submission on a claim.
Other codes that can never be billed with Q05.4
These codes carry an Excludes1 note pointing at Q05.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading Q05.4 alone.
- Q03Congenital hydrocephalus
Risk adjustment
Q05.4 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
Q05.4 is named in 6 Medicare coverage policies — 6 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
- A56722Billing and Coding: Intraoperative Neurophysiological Testing
- A57041Billing and Coding: Somatosensory Testing
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
How Q05.4 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 Q05.4.
- Spina bifida›with hydrocephalus NEC
- Hydrocephalus›congenital›with spina bifida
Related codes at this level
Codes that share Q05. If Q05.4 is not quite right, the correct code is usually one of these.
- Q05.0Cervical spina bifida with hydrocephalus
- Q05.1Thoracic spina bifida with hydrocephalus
- Q05.2Lumbar spina bifida with hydrocephalus
- Q05.3Sacral spina bifida with hydrocephalus
- Q05.5Cervical spina bifida without hydrocephalus
- Q05.6Thoracic spina bifida without hydrocephalus
- Q05.7Lumbar spina bifida without hydrocephalus
- Q05.8Sacral spina bifida without hydrocephalus
- Q05.9Spina bifida, unspecified
Questions about Q05.4
- Is Q05.4 a billable ICD-10-CM code?
- Yes. Q05.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does Q05.4 sit in the tabular list?
- Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0), in the block Congenital malformations of the nervous system (Q00-Q07).