P11.1 — Other specified brain damage due to birth injury
P11.1 is a billable, specific ICD-10-CM code for other specified brain damage due to birth injury. It is valid for submission on a claim.
Risk adjustment
P11.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 248 Intracranial Hemorrhage0.239 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
P11.1 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
How P11.1 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 P11.1.
- Birth›injury NOS›basal ganglia
- Birth›injury NOS›cerebellum
- Encephalopathy›in›birth injury
- Pressure›brain›injury at birth NEC
- Birth›injury NOS›meninges›brain
Related codes at this level
Codes that share P11. If P11.1 is not quite right, the correct code is usually one of these.
Questions about P11.1
- Is P11.1 a billable ICD-10-CM code?
- Yes. P11.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does P11.1 sit in the tabular list?
- Certain conditions originating in the perinatal period (P00-P96), in the block Birth trauma (P10-P15).