A50.04 ICD-10-CM Code: Early congenital syphilitic pneumonia
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)
A50.04
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceEarly congenital syphilitic pneumonia
This is a lung infection caused by syphilis that a baby acquires from their mother before birth, occurring within the first two years of life. It causes inflammation and fluid buildup in the lungs, making it difficult for the infant to breathe.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Any congenital syphilitic condition specified as early or manifest less than two years after birth.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A50.04 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A50.04 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A50.04 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A50.04 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A50.04 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A50.04 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is A50.04 an HCC code?
No. A50.04 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
A50.04 is the ICD-10-CM diagnosis code for early congenital syphilitic pneumonia. This is a lung infection caused by syphilis that a baby acquires from their mother before birth, occurring within the first two years of life. It causes inflammation and fluid buildup in the lungs, making it difficult for the infant to breathe. A50.04 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).
A50.04 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code is specific to early congenital syphilis with pneumonia manifestation; verify documentation confirms both the congenital syphilis diagnosis and pulmonary involvement before coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A50.04 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is specific to early congenital syphilis with pneumonia manifestation; verify documentation confirms both the congenital syphilis diagnosis and pulmonary involvement before coding
- •Ensure this code is used only for infants/young children with documented maternal syphilis transmission; coordinate with the maternal syphilis code (A50.0x series) in the medical record for complete clinical picture