P09.5 ICD-10-CM Code: Abnormal findings on neonatal screening for critical congenital heart disease
P09.5 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Abnormal findings on neonatal screening (P09)
P09.5
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAbnormal findings on neonatal screening for critical congenital heart disease
Abnormal newborn screening results indicating a critical heart defect that requires urgent evaluation and possible intervention.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Neonatal congenital heart disease screening failure
Excludes 2
Official- nonspecific serologic evidence of human immunodeficiency virus [HIV] (R75)
Related Child Codes
Includes
Official- Abnormal findings on state mandated newborn screens
- Failed newborn screening
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for P09.5 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for P09.5 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for P09.5 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for P09.5 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is P09.5 an HCC code?
No. P09.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- P09.5
- Description
- Abnormal findings on neonatal screening for critical congenital heart disease
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
P09.5 is the ICD-10-CM diagnosis code for abnormal findings on neonatal screening for critical congenital heart disease. Abnormal newborn screening results indicating a critical heart defect that requires urgent evaluation and possible intervention. P09.5 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering abnormal findings on neonatal screening (p09).
P09.5 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 reflects pulse oximetry screening results; abnormal results typically trigger immediate echocardiography and cardiology consultation.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P09.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code reflects pulse oximetry screening results; abnormal results typically trigger immediate echocardiography and cardiology consultation
- •Document the specific screening method used (pulse oximetry, cardiac imaging) and results in the medical record