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ICD-10 Guide
ICD-10 CodesChapter 17: Congenital malformations and chromosomal abnormalitiesQ05

Q05

Billable

Spina bifida

Chapter 17:Congenital malformations and chromosomal abnormalities

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q05 is a billable code used to indicate a diagnosis of spina bifida.

Key Diagnostic Point:

Spina bifida is a congenital malformation of the neural tube that occurs when the spinal column does not close completely during fetal development. This condition can lead to varying degrees of disability, depending on the location and severity of the defect. The most common form is spina bifida occulta, where the defect is covered by skin and may not cause significant symptoms. More severe forms, such as spina bifida cystica, involve protrusion of the spinal cord and nerves through the defect, leading to neurological impairment, paralysis, and other complications. Associated conditions may include hydrocephalus, where cerebrospinal fluid accumulates in the brain, and Chiari malformation, where brain tissue extends into the spinal canal. Diagnosis is typically made through prenatal ultrasound or postnatal imaging. Management may involve surgical intervention, physical therapy, and ongoing medical care to address associated complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the condition
  • Need for detailed documentation of associated conditions
  • Potential for multiple surgical interventions and follow-up care
  • Differentiation between types of spina bifida and related anomalies

Audit Risk Factors

  • Inadequate documentation of the severity and type of spina bifida
  • Failure to document associated conditions such as hydrocephalus
  • Incorrect coding of surgical procedures related to spina bifida
  • Misclassification of the type of spina bifida

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Detailed records of developmental milestones, neurological assessments, and interventions.

Common Clinical Scenarios

Management of spina bifida in infants, including surgical repair and ongoing therapy.

Billing Considerations

Consideration of comorbidities such as bladder and bowel dysfunction, and the need for multidisciplinary care.

Genetics

Documentation Requirements

Genetic counseling notes, family history, and any chromosomal analysis results.

Common Clinical Scenarios

Assessment of genetic syndromes associated with spina bifida and counseling for recurrence risk.

Billing Considerations

Understanding the genetic basis of neural tube defects and implications for family planning.

Coding Guidelines

Inclusion Criteria

Use Q05 When
  • Follow the ICD
  • CM guidelines for coding congenital malformations, ensuring specificity in the type of spina bifida and associated conditions
  • Document all relevant clinical findings and interventions

Exclusion Criteria

Do NOT use Q05 When
No specific exclusions found.

Related CPT Codes

62270CPT Code

Lumboperitoneal shunt placement

Clinical Scenario

Used in cases of hydrocephalus associated with spina bifida.

Documentation Requirements

Document indication for shunt placement and pre-operative assessments.

Specialty Considerations

Pediatric neurosurgery may be involved in the procedure.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding spina bifida, enabling better tracking of outcomes and resource allocation for affected patients.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding spina bifida, enabling better tracking of outcomes and resource allocation for affected patients.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding spina bifida, enabling better tracking of outcomes and resource allocation for affected patients.

Resources

Clinical References

  • •
    CDC - Spina Bifida

Coding & Billing References

  • •
    CDC - Spina Bifida

Frequently Asked Questions

What is the difference between spina bifida occulta and spina bifida cystica?

Spina bifida occulta is a mild form where the defect is covered by skin and may not cause symptoms, while spina bifida cystica involves a more severe defect with protrusion of the spinal cord and nerves, often leading to significant neurological impairment.