2027 ICD-10-CM Diagnosis Code Q01.2Occipital encephalocele
ICD-10-CM Codes›Q00-Q99›Q00-Q07›Q01
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 182
- POA Exempt
- Chronic Condition
Q01.2 is a billable ICD-10-CM diagnosis code for occipital encephalocele. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 91 through 93, 791, 793. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 14 closely related codes. The code is exempt from POA reporting. Coders also document this condition as brain stem herniation. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Nervous system congenital anomalies.
For Medicare Advantage risk adjustment, Q01.2 maps to CMS-HCC Category 182 (Spinal Cord Disorders/Injuries) under the V28 model, adding a risk factor of about 0.478 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Present on Admission (POA)Billing
Q01.2 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Congenital malformations of the nervous system (Q00-Q07).
Medicare Risk Adjustment (HCC)Billing
Q01.2 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.
- Brain stem herniation
- Chiari malformation
- Chiari malformation type III
- Lethal occipital encephalocele, skeletal dysplasia syndrome
- Occipital encephalocele
- Occipital meningocele
- Retinal detachment and occipital encephalocele
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Q01.2: its own notes plus those printed at Q01 and Chapter 17. 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.
- Arnold-Chiari syndrome, type III
- encephalocystocele
- encephalomyelocele
- hydroencephalocele
- hydromeningocele, cranial
- meningocele, cerebral
- meningoencephalocele
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
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 not for use 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 Q01.2, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming Q01.2: they are not reported together with it, unless the two conditions are unrelated.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
occipital Q01.2
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Encephalocele
brain tissue herniation through a congenital or acquired defect in the skull. the majority of congenital encephaloceles occur in the occipital or frontal regions. clinical features include a protuberant mass that may be pulsatile. the quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur.
Patient EducationClinical
Neural Tube Defects
Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Q01.2 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Q01.2Overview
What is the ICD-10 code for occipital encephalocele?
The ICD-10-CM code for occipital encephalocele is Q01.2 (sometimes written as Q012). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Q01.2 (Encephalocele) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report occipital encephalocele on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Q01.2 group to?
When occipital encephalocele is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 91, 92, 93, with relative weights from 0.7783 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Q01.2 a CC or MCC?
CMS lists Q01.2 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 14 closely related codes in its exclusion list.
Is Q01.2 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for occipital encephalocele on inpatient claims. The code appears in the Congenital malformations of the nervous system (Q00-Q07) range of the CMS exempt list.
What HCC is Q01.2?
Q01.2 (occipital encephalocele) maps to CMS-HCC Category 182 (Spinal Cord Disorders/Injuries), commonly written as HCC 182, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 72 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 155.
Does Q01.2 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, Q01.2 adds a risk adjustment factor of about 0.478 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.270 to 0.478 depending on the payment segment). A more severe related category (HCC 180, HCC 181, HCC 191, and HCC 192) supersedes it when both are reported. See the full factor table on the HCC 182 category page.
