ICD-10 Q06.9
Billable / Specific HCC v28: 72Congenital malformation of spinal cord, unspecified
About ICD-10-CM Q06.9
ICD-10-CM code Q06.9 represents Congenital malformation of spinal cord, unspecified. This is a billable/specific code in the Congenital Malformations chapter (block Q06). The 2026 edition of ICD-10-CM Q06.9 became effective on October 1, 2025.
Coding Tips for Q06.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Q06.9 is a CMS-HCC v28 risk-adjustment code (category 72). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under Q06.9. Per CMS ICD-10-CM Tabular 2026.
- Congenital anomaly NOS of spinal cord
- Congenital deformity NOS of spinal cord
- Congenital disease or lesion NOS of spinal cord
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for Q06.9
Local Coverage Determinations (LCDs) from CMS MACs that list Q06.9 as a covered diagnosis.
Showing top 10 of 21 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing Q06.9.
3 Cigna
1 Medicare
5 Aetna
CPT Codes Commonly Billed with Q06.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert Q06.9 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 |
|---|---|---|
| Q06.9 | 74259 | 10000 |
| Q06.9 | 7429 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To Q06.9
Other codes in section Q00-Q07 (Congenital malformations of the nervous system).
ICD-10 Q06.9, Billing FAQ
Is ICD-10 code Q06.9 billable? +
Yes, Q06.9 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 Q06.9? +
ICD-10 Q06.9 includes: Congenital anomaly NOS of spinal cord; Congenital deformity NOS of spinal cord; Congenital disease or lesion NOS of spinal cord.
Does Q06.9 affect Medicare Advantage HCC risk adjustment? +
Yes. Q06.9 maps to CMS-HCC v28 category 72. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does Q06.9 map to? +
Per CMS GEMs, Q06.9 maps to ICD-9 codes: 74259, 7429. 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 July 17, 2026.
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