Q06.8
BillableOther specified congenital malformations of spinal cord
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q06.8 an HCC code?
Yes. Q06.8 maps to Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model (and Spinal Cord Disorders/Injuries under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for Q06.8
For Q06.8to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed Q06.8 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q06.8 is the ICD-10-CM diagnosis code for other specified congenital malformations of spinal cord. Other birth defects of the spinal cord that don't fit into the more specific categories listed above. Q06.8 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering congenital malformations of the nervous system (q00-q07).
Under the CMS-HCC V28 risk adjustment model, Q06.8 maps to Spinal Cord Disorders/Injuries (HCC 182) with a community, non-dual, aged base RAF weight of 0.282. Under the older V24 model, Q06.8 mapped to the same category but with a base RAF weight of 0.464 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Use only when a specific congenital spinal cord malformation is documented but doesn't match Q06.0-Q06.4. Because Q06.8 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for Q06.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This category captures other specified congenital spinal cord malformations not classified elsewhere, representing various rare developmental anomalies that can significantly impact neurological function. These conditions require individualized management approaches and ongoing monitoring for complications.
Documentation Requirements
- ✓Specific description of the spinal cord malformation
- ✓Imaging studies confirming the anomaly
- ✓Neurological examination findings
- ✓Associated functional impairments
- ✓Developmental history and milestones
- ✓Treatment interventions and responses
- ✓Monitoring for progressive changes
- ✓Multidisciplinary care coordination