ICD-10 A05.1
Billable / Specific CCBotulism food poisoning
About ICD-10-CM A05.1
ICD-10-CM code A05.1 represents Botulism food poisoning. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block A05). The 2026 edition of ICD-10-CM A05.1 became effective on October 1, 2025.
Coding Tips for A05.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
A05.1 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under A05.1. Per CMS ICD-10-CM Tabular 2026.
- Botulism NOS
- Classical foodborne intoxication due to Clostridium botulinum
Type 1 Excludes
Pure excludes, these codes can never be coded together with A05.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- infant botulism (A48.51)
- wound botulism (A48.52)
Inpatient DRG Impact, CC
codes Botulism food poisoning. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for A05.1
Local Coverage Determinations (LCDs) from CMS MACs that list A05.1 as a covered diagnosis.
Showing top 10 of 758 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing A05.1.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with A05.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95860 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95874 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95937 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- G0255 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95861 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95913 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95887 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95863 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95873 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
- 95909 CMS LCD: Billing and Coding: Nerve Conduction Studies and Electromyography CMS LCD
Convert A05.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| A05.1 | 0051 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To A05.1
Other codes in section A00-A09 (Intestinal infectious diseases).
ICD-10 A05.1, Billing FAQ
Is ICD-10 code A05.1 billable? +
Yes, A05.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to A05.1? +
ICD-10 A05.1 includes: Botulism NOS; Classical foodborne intoxication due to Clostridium botulinum.
What codes are Type 1 Excludes for A05.1? +
Type 1 Excludes (never code together with A05.1): infant botulism (A48.51); wound botulism (A48.52)
Is A05.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with A05.1? +
Procedures frequently paired with A05.1 include: 95860, 95874, 95937, G0255, 95861.
What ICD-9 codes does A05.1 map to? +
Per CMS GEMs, A05.1 maps to ICD-9 codes: 0051. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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