2026 ICD-10-CM Diagnosis Code P11.5Birth injury to spine and spinal cord

ICD-10-CM Codes›P00–P96›P10-P15›P11

ICD-10-CM P11.5
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

P11.5 is a billable ICD-10-CM diagnosis code for birth injury to spine and spinal cord. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 791, 793. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Birth trauma.

For Medicare Advantage risk adjustment, P11.5 maps to CMS-HCC Category 182 (Spinal Cord Disorders/Injuries) under the V28 model, adding a risk factor of about 0.478 for a community, non-dual, aged beneficiary in payment year 2026.

Code Identity

ICD-10-CM Code
P11.5
Billable Status
Yes — Valid for Submission
Code Describes
Birth injury to spine and spinal cord
Short Description
Birth injury to spine and spinal cord
Same as the full description in the CMS dataset.
Parent Code
P11
Other birth injuries to central nervous system

Code Classification

ChapterP00–P96Certain conditions originating in the perinatal period
SectionP10-P15Birth trauma
CategoryP11Other birth injuries to central nervous system
This CodeP11.5Birth injury to spine and spinal cord

Medicare Risk Adjustment (HCC)Billing

P11.5 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.

CMS-HCC V28 Category (Payment Model)
HCC 182— Spinal Cord Disorders/Injuries
Payment HCC · PY 2026 one of 251 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.478
community, non-dual, aged · ranges 0.270–0.478 across segments
Hierarchy
Superseded by HCC 180, HCC 181, HCC 191, and HCC 192
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Part D (RxHCC)
Not mapped
P11.5 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Closed fracture of vertebral column
  • Dislocation of spine due to birth trauma
  • Fracture of spine due to birth trauma
  • Laceration of spinal cord
  • Paralysis from birth trauma
  • Spastic paralysis due to birth injury
  • Spastic paralysis due to spinal birth injury
  • Spinal cord injury due to birth trauma
  • Spinal cord laceration due to birth trauma
  • Spinal cord rupture
  • Spinal cord rupture due to birth trauma
  • Spine injury due to birth trauma
  • Traumatic subluxation of spine due to birth trauma

Tabular List NotesGuidance

Coding notes and annotation back-references applicable to this code.

Inclusion Terms

  • Fracture of spine due to birth injury

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR PNL008
Birth trauma
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Childbirth Problems

Childbirth is the process of giving birth to a baby. It includes labor and delivery. Usually everything goes well, but problems can happen. They may cause a risk to the mother, baby, or both. Some of the more common childbirth problems include:

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert P11.5 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
767.4 Spinal cord inj at birth
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About P11.5Overview

What is the ICD-10 code for birth injury to spine and spinal cord?

The ICD-10-CM code for birth injury to spine and spinal cord is P11.5 (sometimes written as P115). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

Is P11.5 (Other birth injuries to central nervous system) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report birth injury to spine and spinal cord on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does P11.5 group to?

When birth injury to spine and spinal cord is the principal diagnosis on an inpatient stay, it groups to MS-DRG 791, 793, with relative weights from 4.0590 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.

What is the ICD-9 equivalent of P11.5?

Under the General Equivalence Mappings, birth injury to spine and spinal cord converts to ICD-9-CM 767.4 (spinal cord inj at birth). The mapping is a direct match.

What HCC is P11.5?

P11.5 (birth injury to spine and spinal cord) maps to CMS-HCC Category 182 (Spinal Cord Disorders/Injuries), commonly written as HCC 182, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It does not map to any RxHCC in the Part D prescription drug model.

Does P11.5 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, P11.5 adds a risk adjustment factor of about 0.478 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.270 to 0.478 depending on the payment segment). A more severe related category (HCC 180, HCC 181, HCC 191, and HCC 192) supersedes it when both are reported. See the full factor table on the HCC 182 category page.