2027 ICD-10-CM Diagnosis Code P11.0Cerebral edema due to birth injury
ICD-10-CM Codes›P00–P96›P10-P15›P11
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 248
- Not Chronic
P11.0 is a billable ICD-10-CM diagnosis code for cerebral edema due to birth injury. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 39 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Birth trauma.
For Medicare Advantage risk adjustment, P11.0 maps to CMS-HCC Category 248 (Intracranial Hemorrhage) under the V28 model, adding a risk factor of about 0.239 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
P11.0 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Cerebral edema due to birth injury
- Cerebral injury due to birth trauma
- Traumatic cerebral edema
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to P11.0: its own notes plus those printed at Chapter 16. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Codes from this chapter are for use on newborn records only, never on maternal records
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name P11.0, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming P11.0: they are not reported together with it, unless the two conditions are unrelated.
Excludes2 1
These codes carry an Excludes2 note naming P11.0: its condition is not part of those codes, and both may be reported when the patient has both.
- Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Brain Diseases
Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body.
Read the full article at MedlinePlus
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Convert P11.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About P11.0Overview
What is the ICD-10 code for cerebral edema due to birth injury?
The ICD-10-CM code for cerebral edema due to birth injury is P11.0 (sometimes written as P110). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is P11.0 (Other birth injuries to central nervous system) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report cerebral edema due to birth injury on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does P11.0 group to?
When cerebral edema due to birth injury is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, with relative weights from 4.1073 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is P11.0 a CC or MCC?
CMS lists P11.0 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 39 closely related codes in its exclusion list.
What is the ICD-9 equivalent of P11.0?
Under the General Equivalence Mappings, cerebral edema due to birth injury converts to ICD-9-CM 767.0 (cerebral hem at birth). The mapping is approximate, so confirm the match fits the documentation.
What HCC is P11.0?
P11.0 (cerebral edema due to birth injury) maps to CMS-HCC Category 248 (Intracranial Hemorrhage), commonly written as HCC 248, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It does not map to any RxHCC in the Part D prescription drug model.
Does P11.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, P11.0 adds a risk adjustment factor of about 0.239 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.081 to 0.377 depending on the payment segment). HCC 248 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 248 category page.
