2026 ICD-10-CM Diagnosis Code Q87.11Prader-Willi syndrome

ICD-10-CM Codes›Q00-Q99›Q80-Q89›Q87

ICD-10-CM Q87.11
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

Q87.11 is a billable ICD-10-CM diagnosis code for Prader-Willi syndrome. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 564 through 566. The code is exempt from POA reporting. Coders also document this condition as genetic syndromic childhood obesity. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Other specified and unspecified congenital anomalies.

Code Identity

ICD-10-CM Code
Q87.11
Billable Status
Yes — Valid for Submission
Code Describes
Prader-Willi syndrome
Short Description
Prader-Willi syndrome
Same as the full description in the CMS dataset.
Parent Code
Q87.1
Congenital malformation syndromes predominantly associated with short stature

Code Classification

ChapterQ00-Q99Congenital malformations, deformations and chromosomal abnormalities
SectionQ80-Q89Other congenital malformations
CategoryQ87Other specified congenital malformation syndromes affecting multiple systems
This CodeQ87.11Prader-Willi syndrome

Present on Admission (POA)Billing

Q87.11 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Genetic syndromic childhood obesity
  • Prader-Willi syndrome

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Prader-Willi syndrome
    • Syndrome
      • Prader-Willi

Clinical ClassificationClinical

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

CCSR MAL010
Other specified and unspecified congenital anomalies
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Prader-Willi Syndrome

Prader-Willi Syndrome (PWS) is a rare genetic disorder. It causes poor muscle tone, low levels of sex hormones and a constant feeling of hunger. The part of the brain that controls feelings of fullness or hunger does not work properly in people with PWS. They overeat, leading to obesity.

Read the full article at MedlinePlus

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

Code History & ChangesHistory

Replacement Q87.11 replaces the following previously assigned code(s):

  • Q87.1 - Congenital malform syndromes predom assoc w short stature
FY 2020AddedAdded to the ICD-10-CM code setEffective October 1, 2019.
FY 2021–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About Q87.11Overview

Is Q87.11 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report Prader-Willi syndrome on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does Q87.11 group to?

When Prader-Willi syndrome is the principal diagnosis on an inpatient stay, it groups to MS-DRG 564, 565, 566, with relative weights from 0.7493 to 1.5436 depending on complications. Higher weights mean higher Medicare reimbursement.

Is Q87.11 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 Prader-Willi syndrome on inpatient claims.

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

  • The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
  • The condition places limitations on self-care, independent living, and social interactions.