2027 ICD-10-CM Diagnosis Code Q05.9Spina bifida, unspecified
ICD-10-CM Codes›Q00-Q99›Q00-Q07›Q05
- Billable — Valid for Submission
- Risk Adjusts — HCC 182
- POA Exempt
- Chronic Condition
Q05.9 is a billable ICD-10-CM diagnosis code for spina bifida, unspecified. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 91 through 93, 791, 793. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nervous system congenital anomalies.
For Medicare Advantage risk adjustment, Q05.9 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 2027.
Code Identity
Code Classification
Present on Admission (POA)Billing
Q05.9 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Congenital malformations of the nervous system (Q00-Q07).
Medicare Risk Adjustment (HCC)Billing
Q05.9 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 2027.
Source: CMS Payment Year 2027 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.
- Aqueduct of Sylvius anomaly
- Benign neoplasm of spinal meninges
- Congenital cleft hand
- Congenital meningocele
- Congenital spinal meningocele
- Congenital stenosis of aqueduct of Sylvius
- Cutaneous lesion resulting from spina bifida
- Hemimyelocele
- Holorachischisis
- Lateral meningocele
- Lipoma co-occurrent with spina bifida
- Lipomeningocele
- Lipomyelomeningocele
- Meningocele
- Meningomyelocele
- Myelic limited dorsal malformation
- Myelocele
- Myelocystocele
- Myelomeningocele without hydrocephalus
- Neurogenic urinary bladder due to spina bifida
- Non-terminal myelocystocele
- Port-wine stain associated with spinal dysraphism
- Port-wine stain of skin
- Posterior meningocele
- Pressure injury due to spina bifida
- Rachischisis
- Rachischisis partialis
- Spina bifida
- Spina bifida aperta
- Spina bifida with stenosis of aqueduct of Sylvius
- Spina bifida without hydrocephalus
- Spina bifida without hydrocephalus - closed
- Spina bifida without hydrocephalus - open
- Split hand, obstructive uropathy, spina bifida, diaphragmatic defect syndrome
- Terminal myelocystocele
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Q05.9: its own notes plus those printed at Q05 and Chapter 17. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- hydromeningocele (spinal)
- meningocele (spinal)
- meningomyelocele
- myelocele
- myelomeningocele
- rachischisis
- spina bifida (aperta)(cystica)
- syringomyelocele
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
Notes
General instructions on how these codes are used.
- Codes from this chapter are not for use on maternal records
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name Q05.9, its category, or a range that includes it.
Excludes1 3
These codes carry an Excludes1 note naming Q05.9: they are not reported together with it, unless the two conditions are unrelated.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Spina bifida (aperta) Q05.9
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Spinal Dysraphism
congenital defects of closure of one or more vertebral arches, which may be associated with malformations of the spinal cord, nerve roots, congenital fibrous bands, lipomas, and congenital cysts. these malformations range from mild (e.g., spina bifida occulta) to severe, including rachischisis where there is complete failure of neural tube and spinal cord fusion, resulting in exposure of the spinal cord at the surface. spinal dysraphism includes all forms of spina bifida. the open form is called spina bifida cystica and the closed form is spina bifida occulta. (from joynt, clinical neurology, 1992, ch55, p34)
Patient EducationClinical
Spina Bifida
Spina bifida is a neural tube defect - a type of birth defect of the brain, spine, or spinal cord. It happens if the spinal column of the fetus doesn't close completely during the first month of pregnancy. This can damage the nerves and spinal cord. Screening tests during pregnancy can check for spina bifida.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Q05.9 to ICD-9-CMHistory
Code HistoryHistory
Questions About Q05.9Overview
What is the ICD-10 code for spina bifida, unspecified?
The ICD-10-CM code for spina bifida, unspecified is Q05.9 (sometimes written as Q059). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Q05.9 (Spina bifida) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report spina bifida, unspecified on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Q05.9 group to?
When spina bifida, unspecified is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 91, 92, 93, with relative weights from 0.7783 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Q05.9 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for spina bifida, unspecified on inpatient claims. The code appears in the Congenital malformations of the nervous system (Q00-Q07) range of the CMS exempt list.
Can Q05.9 be reported with a code from Q07.0?
Not as a rule. The Excludes1 note at Q05, which applies to Q05.9, lists "Arnold-Chiari syndrome, type II (Q07.0-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is Q05.9?
Q05.9 (spina bifida, unspecified) 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 2027. It mapped to HCC 72 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 155.
Does Q05.9 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, Q05.9 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.
