P35.0 — Congenital rubella syndrome
P35.0 is a billable, specific ICD-10-CM code for congenital rubella syndrome. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Congenital rubella pneumonitis
Other codes that can never be billed with P35.0
These codes carry an Excludes1 note pointing at P35.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P35.0 alone.
Risk adjustment
P35.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
P35.0 is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56726Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
- A57071Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
How P35.0 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to P35.0.
- Pneumonitis›congenital rubella
- Pneumonitis›rubella, congenital
- Rubella›congenital
- Syndrome›rubella(congenital)
- Infection, infected, infective›congenital›rubella
- Rubella›maternal›manifest rubella in infant
- Syndrome›congenital›rubella(manifest)
Related codes at this level
Codes that share P35. If P35.0 is not quite right, the correct code is usually one of these.
Questions about P35.0
- Is P35.0 a billable ICD-10-CM code?
- Yes. P35.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does P35.0 sit in the tabular list?
- Certain conditions originating in the perinatal period (P00-P96), in the block Infections specific to the perinatal period (P35-P39).