Version 2024

2024 ICD-10-CM Diagnosis Code S06.2XAD

Diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter

ICD-10-CM Code:: S06.2XAD
ICD-10 Code for:: Diffuse TBI with LOC status unknown, subsequent encounter
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Chronic
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Code Information
Approximate Synonyms
Clinical Classification
Coding Guidelines
Tabular List of Diseases and Injuries
Diagnostic Related Groups Mapping
Present on Admission (POA)
Replacement Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Injury, poisoning and certain other consequences of external causes
(S00–T88)
- Injuries to the head
  (S00-S09)
  - Intracranial injury
    (S06)

S06.2XAD is a billable diagnosis code used to specify a medical diagnosis of diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

S06.2XAD is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like diffuse traumatic brain injury with loss of consciousness status unknown. According to ICD-10-CM Guidelines a "subsequent encounter" occurs when the patient is receiving routine care for the condition during the healing or recovery phase of treatment. Subsequent diagnosis codes are appropriate during the recovery phase, no matter how many times the patient has seen the provider for this condition. If the provider needs to adjust the patient's care plan due to a setback or other complication, the encounter becomes active again.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Cerebral cortex laceration with concussion
Contusion of cerebral cortex
Contusion of cerebrum with open intracranial wound
Cortex contusion with open intracranial wound
Cortex laceration
Diffuse injury of brainstem
Diffuse injury of cerebellum
Diffuse injury of cerebrum
Intracranial hemorrhage co-occurrent and due to complex wound of head
Laceration of brain without open intracranial wound
Multiple intracranial injuries
Multiple traumatic hemorrhages of brain tissue
Open skull fracture with intracranial hemorrhage
Traumatic hemorrhage of cerebral white matter

Clinical Classification

Clinical Category is Traumatic brain injury (TBI); concussion, subsequent encounter
CCSR Category Code: INJ045
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Coding Guidelines

The appropriate 7th character is to be added to each code from block Intracranial injury (S06). Use the following options for the aplicable episode of care:

A - initial encounter
D - subsequent encounter
S - sequela

S06.2XAD is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
949	AFTERCARE WITH CC/MCC	23	1.0361
950	AFTERCARE WITHOUT CC/MCC	23	0.6282

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Present on Admission (POA)

S06.2XAD is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Replacement Code

S062XAD replaces the following previously assigned ICD-10-CM code(s):

S06.2X9D - Diffuse TBI w loss of consciousness of unsp duration, subs

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

S06 Intracranial injury.
S06.0 Concussion.
S06.0X Concussion.
S06.0X0 Concussion without loss of consciousness.
S06.0X0A Concussion without loss of consciousness, initial encounter.
S06.0X0D Concussion without loss of consciousness, subsequent encounter.
S06.0X0S Concussion without loss of consciousness, sequela.
S06.0X1 Concussion with loss of consciousness of 30 minutes or less.
S06.0X1A Concussion with loss of consciousness of 30 minutes or less, initial encounter.
S06.0X1D Concussion with loss of consciousness of 30 minutes or less, subsequent encounter.
S06.0X1S Concussion with loss of consciousness of 30 minutes or less, sequela.
S06.0X9 Concussion with loss of consciousness of unspecified duration.
S06.0X9A Concussion with loss of consciousness of unspecified duration, initial encounter.
S06.0X9D Concussion with loss of consciousness of unspecified duration, subsequent encounter.
S06.0X9S Concussion with loss of consciousness of unspecified duration, sequela.
S06.0XA Concussion with loss of consciousness status unknown.
S06.0XAA Concussion with loss of consciousness status unknown, initial encounter.
S06.0XAD Concussion with loss of consciousness status unknown, subsequent encounter.
S06.0XAS Concussion with loss of consciousness status unknown, sequela.
S06.1 Traumatic cerebral edema.
S06.1X Traumatic cerebral edema.
S06.1X0 Traumatic cerebral edema without loss of consciousness.
S06.1X0A Traumatic cerebral edema without loss of consciousness, initial encounter.
S06.1X0D Traumatic cerebral edema without loss of consciousness, subsequent encounter.
S06.1X0S Traumatic cerebral edema without loss of consciousness, sequela.
S06.1X1 Traumatic cerebral edema with loss of consciousness of 30 minutes or less.
S06.1X1A Traumatic cerebral edema with loss of consciousness of 30 minutes or less, initial encounter.
S06.1X1D Traumatic cerebral edema with loss of consciousness of 30 minutes or less, subsequent encounter.
S06.1X1S Traumatic cerebral edema with loss of consciousness of 30 minutes or less, sequela.
S06.1X2 Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes.
S06.1X2A Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter.
S06.1X2D Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, subsequent encounter.
S06.1X2S Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, sequela.
S06.1X3 Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes.
S06.1X3A Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter.
S06.1X3D Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, subsequent encounter.
S06.1X3S Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela.
S06.1X4 Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours.
S06.1X4A Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial encounter.
S06.1X4D Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, subsequent encounter.
S06.1X4S Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, sequela.
S06.1X5 Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level.
S06.1X5A Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter.
S06.1X5D Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, subsequent encounter.
S06.1X5S Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela.
S06.1X6 Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving.
S06.1X6A Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter.
S06.1X6D Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, subsequent encounter.
S06.1X6S Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela.
S06.1X7 Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness.
S06.1X7A Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter.

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - Code Added, effective from 10/1/2022 through 9/30/2023

Footnotes

[1] Chronic - a chronic condition code indicates a condition lasting 12 months or longer and its effect on the patient based on one or both of the following criteria:

The condition results in the need for ongoing intervention with medical products,treatment, services, and special equipment
The condition places limitations on self-care, independent living, and social interactions.