What is ICD-10 code P11.5?

P11.5 is the ICD-10-CM diagnosis code for Birth injury to spine and spinal cord. Injury to the baby's spine or spinal cord that occurs during the birth process, which may result in temporary or permanent neurological effects. P11.5 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. P11.5 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. P11.5 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. P11.5 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does P11.5 map to under V28?

P11.5 maps to CMS-HCC V28 HCC 182 (Spinal Cord Disorders/Injuries). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM P11.5: Birth injury to spine

P11.5 maps to CMS-HCC V28 182. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupP11.5

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Birth trauma (P10-P15)

P11.5

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Birth injury to spine and spinal cord

Injury to the baby's spine or spinal cord that occurs during the birth process, which may result in temporary or permanent neurological effects.

Buddy Insight

Spinal cord birth injury represents severe trauma that can result in permanent neurological deficits including paralysis and sensory loss.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 182

Spinal Cord Disorders/Injuries

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 110

HHS-HCC 110 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

P11Other birth injuries to central nervous system P11.5Birth injury to spine and spinal cord

Inclusion Terms

Official

Fracture of spine due to birth injury

Excludes 2

Official

congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from P00-P96
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from P00-P96
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from P00-P96
neoplasms (C00-D49)Inherited from P00-P96
tetanus neonatorum (A33)Inherited from P00-P96

Related Codes

Official

P11.0Cerebral edema due to birth injury P11.1Other specified brain damage due to birth injury P11.2Unspecified brain damage due to birth injury P11.3Birth injury to facial nerve P11.4Birth injury to other cranial nerves

Includes

Official

conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs laterInherited from P00-P96

Excludes 1

Official

No Excludes 1 notes are included in this display for P11.5. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for P11.5. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for P11.5. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for P11.5. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Evidence of spinal cord or vertebral injury from birth trauma

Neurological examination documenting motor/sensory deficits

Imaging studies showing spinal injury when available

Documentation of difficult delivery or birth complications

MEAT Support

HCC Buddy guidance

Evidence of spinal cord or vertebral injury from birth trauma

Neurological examination documenting motor/sensory deficits

Imaging studies showing spinal injury when available

Documentation of difficult delivery or birth complications

Audit Caution

HCC Buddy guidance

Confusing spinal cord injury with brachial plexus injury

Missing birth trauma etiology in documentation

Failing to document neurological assessment findings

Not distinguishing from congenital spinal abnormalities

Common Mistakes

HCC Buddy guidance

P14.1 — Erb's paralysis due to birth injury (brachial plexus vs spinal cord)

P14.0 — Klumpke's paralysis due to birth injury (peripheral vs central injury)

P11.1 — Other specified brain damage due to birth injury (brain vs spinal)

G82.20 — Paraplegia, unspecified (acquired paraplegia vs birth injury)

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 P11.5 an HCC code?

Yes. P11.5 (Birth injury to spine and spinal cord) maps to HCC 182, Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.478. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: P11.5 is billable and maps to V28 HCC 182, Spinal Cord Disorders/Injuries. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: P11.5
Description: Birth injury to spine and spinal cord
HCC (V28): HCC 182 — Spinal Cord Disorders/Injuries
RAF reference coefficient: 0.478
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 182, Spinal Cord Disorders/Injuries

0.478

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work P11.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for P11.5

For P11.5, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

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What This Code Means

P11.5 is the ICD-10-CM diagnosis code for birth injury to spine and spinal cord. Injury to the baby's spine or spinal cord that occurs during the birth process, which may result in temporary or permanent neurological effects. P11.5 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering birth trauma (p10-p15).

Under the CMS-HCC V28 risk adjustment model, P11.5 maps to Spinal Cord Disorders/Injuries (HCC 182) with a source-labeled community, non-dual, aged reference coefficient of 0.478. No V24 mapping is shown for P11.5; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document the specific location of the spinal injury (cervical, thoracic, lumbar) if documented in the medical record. For P11.5, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for P11.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific location of the spinal injury (cervical, thoracic, lumbar) if documented in the medical record
•Distinguish between spinal fractures and spinal cord injuries, as they may require different codes or additional specificity

Clinical Significance

Spinal cord birth injury represents severe trauma that can result in permanent neurological deficits including paralysis and sensory loss. This condition requires immediate neurological assessment and may necessitate specialized neonatal intensive care with long-term rehabilitation planning for motor and sensory impairments.