2027 ICD-10-CM Diagnosis Code S06.1X2ATraumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter

ICD-10-CM Codes›S00–T88›S00-S09›S06

ICD-10-CM S06.1X2A
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

S06.1X2A is a billable ICD-10-CM diagnosis code for traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 82 through 87, 963 through 965. 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 385 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Traumatic brain injury (TBI); concussion, initial encounter.

For Medicare Advantage risk adjustment, S06.1X2A maps to CMS-HCC Category 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified) under the V28 model, adding a risk factor of about 0.199 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
S06.1X2A
Billable Status
Yes — Valid for Submission
Code Describes
Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter
Short Description
Traumatic cerebral edema w LOC of 31-59 min, init
Parent Code
S06.1X2
Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionS00-S09Injuries to the head
CategoryS06Intracranial injury
This CodeS06.1X2ATraumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter

Medicare Risk Adjustment (HCC)Billing

S06.1X2A 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.

CMS-HCC V28 Category (Payment Model)
HCC 398— Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified
Payment HCC · PY 2027 one of 57 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.199
community, non-dual, aged · ranges 0.052–0.349 across segments
Hierarchy
Superseded by HCC 397
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 167
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 167 · ESRD (V21): HCC 167 · ESRD (V24): HCC 167
ESRD V21 weights: 0.017 dialysis, 0.000–0.184 functioning graft · ESRD V24 weights: 0.043 dialysis, 0.000–0.239 functioning graft
Part D (RxHCC)
Not mapped
S06.1X2A does not risk-adjust in the RxHCC prescription drug model

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.

Coding GuidelinesGuidance

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

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to S06.1X2A: its own notes plus those printed at S06, block S00-S09, and Chapter 19. 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.

From S06 Intracranial injury applies to 569 codes
  • traumatic brain injury
From Block S00-S09 Injuries to the head applies to 1,934 codes
  • injuries of ear
  • injuries of eye
  • injuries of face [any part]
  • injuries of gum
  • injuries of jaw
  • injuries of oral cavity
  • injuries of palate
  • injuries of periocular area
  • injuries of scalp
  • injuries of temporomandibular joint area
  • injuries of tongue
  • injuries of tooth

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From S06 Intracranial injury applies to 569 codes

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.

From Block S00-S09 Injuries to the head applies to 1,934 codes
  • burns and corrosions (T20-T32)
  • effects of foreign body in ear (T16)
  • effects of foreign body in larynx (T17.3)
  • effects of foreign body in mouth NOS (T18.0)
  • effects of foreign body in nose (T17.0-T17.1)
  • effects of foreign body in pharynx (T17.2)
  • effects of foreign body on external eye (T15.-)
  • frostbite (T33-T34)
  • insect bite or sting, venomous (T63.4)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From S06 Intracranial injury applies to 569 codes
  • code, if applicable, to identify mild neurocognitive disorders due to known physiological condition (F06.7-)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Code Also

A second code may be needed to fully describe the condition; the note gives no sequencing direction.

From S06 Intracranial injury applies to 569 codes
  • any associated:
  • open wound of head (S01.-)
  • skull fracture (S02.-)
From Block S00-S09 Injuries to the head applies to 1,934 codes
  • for any associated infection

Notes

General instructions on how these codes are used.

From S06 Intracranial injury applies to 569 codes
  • 7th characters D and S do not apply to codes in category S06 with 6th character 7 - death due to brain injury prior to regaining consciousness, or 8 - death due to other cause prior to regaining consciousness.
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

From S06 Intracranial injury applies to 569 codes
  • The appropriate 7th character is to be added to each code from category S06, except as noted below
Values for category S06 Encounter: Initial, Subsequent, Sequela
  • Ainitial encounter this code
  • Dsubsequent encounter
  • Ssequela

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name S06.1X2A, its category, or a range that includes it.

Excludes1 10

These codes carry an Excludes1 note naming S06.1X2A: they are not reported together with it, unless the two conditions are unrelated.

  • G31.84 Mild cognitive impairment of uncertain or unknown etiology
    cognitive impairment due to intracranial or head injury (S06.-) names S06.-, which includes this code
  • G93.6 Cerebral edema
    traumatic cerebral edema (S06.1-) names S06.1-, which includes this code
  • Block I60-I69 Cerebrovascular diseases
    traumatic intracranial hemorrhage (S06.-) names S06.-, which includes this code
  • I69 Sequelae of cerebrovascular disease
    sequelae of traumatic intracranial injury (S06.-) names S06.-, which includes this code
  • I69.8 Sequelae of other cerebrovascular diseases
    sequelae of traumatic intracranial injury (S06.-) names S06.-, which includes this code
  • I69.9 Sequelae of unspecified cerebrovascular diseases
    sequelae of traumatic intracranial injury (S06.-) names S06.-, which includes this code
  • P52 Intracranial nontraumatic hemorrhage of newborn
    intracranial hemorrhage due to other injury (S06.-) names S06.-, which includes this code
  • S06.0 Concussion
    concussion with other intracranial injuries classified in subcategories S06.1- to S06.6-, and S06.81- to S06.89-, code to specified intracranial injury names S06.1-, which includes this code
  • S06.2 Diffuse traumatic brain injury
    traumatic diffuse cerebral edema (S06.1X-) names S06.1X-, which includes this code
  • S09.0 Injury of blood vessels of head, not elsewhere classified
    injury of cerebral blood vessels (S06.-) names S06.-, which includes this code

Excludes2 2

These codes carry an Excludes2 note naming S06.1X2A: its condition is not part of those codes, and both may be reported when the patient has both.

  • S06.3 Focal traumatic brain injury
    focal cerebral edema (S06.1) names S06.1, which includes this code
  • S06.8A Primary blast injury of brain, not elsewhere classified
    traumatic cerebral edema (S06.1) names S06.1, which includes this code

Code First 5

These codes say to code first a condition named in the note, and S06.1X2A is one of the conditions named.

  • F02 Dementia in other diseases classified elsewhere
    traumatic brain injury (S06.-) names S06.-, which includes this code
  • F06.7 Mild neurocognitive disorder due to known physiological condition
    traumatic brain injury (S06.-) names S06.-, which includes this code
  • F48.2 Pseudobulbar affect
    sequelae of traumatic intracranial injury (S06.-) names S06.-, which includes this code
  • R40.2 Coma
    intracranial injury (S06.-) names S06.-, which includes this code
  • S04 Injury of cranial nerve
    any associated intracranial injury (S06.-) names S06.-, which includes this code

Use Additional Code 1

These codes say to use an additional code from the note, and S06.1X2A is one of the codes named.

  • S07 Crushing injury of head
    intracranial injuries (S06.-) names S06.-, which includes this code

Code Also 2

These codes say S06.1X2A may also be needed to fully describe the condition. The note gives no sequencing direction.

  • S01 Open wound of head
    intracranial injury (S06.-) names S06.-, which includes this code
  • S02 Fracture of skull and facial bones
    any associated intracranial injury (S06.-) names S06.-, which includes this code

Notes 1

These notes mention S06.1X2A.

  • S06 Intracranial injury
    7th characters D and S do not apply to codes in category S06 with 6th character 7 - death due to brain injury prior to regaining consciousness, or 8 - death due to other cause prior to regaining consciousness. names S06, which includes this code

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ008
Traumatic brain injury (TBI); concussion, initial encounter
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Traumatic Brain Injury

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

The full article covers:

  • What is traumatic brain injury (TBI)?
  • What causes traumatic brain injury (TBI)?
  • Who is at risk for traumatic brain injury (TBI)?
  • What are the symptoms of traumatic brain injury (TBI)?
  • How is traumatic brain injury (TBI) diagnosed?
  • What are the treatments for traumatic brain injury (TBI)?
  • Can traumatic brain injury (TBI) be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert S06.1X2A to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
854.02 Brain inj NEC-brief coma
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
348.5 Cerebral edema
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About S06.1X2AOverview

Is S06.1X2A a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character A in S06.1X2A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, such as an emergency visit or first evaluation.

What MS-DRG does S06.1X2A group to?

When traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 85, 964, 83, 84, 965, 82, 86, 87, 963, with relative weights from 0.9219 to 2.6361 depending on complications. Higher weights mean higher Medicare reimbursement.

Is S06.1X2A a CC or MCC?

CMS lists S06.1X2A 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 385 closely related codes in its exclusion list.

Can S06.1X2A be reported with S09.90?

Not as a rule. The Excludes1 note at S06, which applies to S06.1X2A, lists "head injury NOS (S09.90)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What HCC is S06.1X2A?

S06.1X2A (traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter) maps to CMS-HCC Category 398 (Major Head Injury with Loss of Consciousness < 1 Hour or Unspecified), commonly written as HCC 398, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 167 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.

Does S06.1X2A risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, S06.1X2A adds a risk adjustment factor of about 0.199 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.052 to 0.349 depending on the payment segment). A more severe related category (HCC 397) supersedes it when both are reported. See the full factor table on the HCC 398 category page.