S06.9X5A: Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.9X5A is a billable, specific ICD-10-CM code for unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter. It is valid for submission on a claim.
Check S06.9X5A with the rest of the claim: free scrubber7th character "A": initial encounter
The appropriate 7th character is to be added to each code from category S06, except as noted below
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes1 inherited from the categories above S06.9X5A
A category’s note binds every code beneath it.
Written on S06.9: Unspecified intracranial injury
Other codes that can never be billed with S06.9X5A
Their own Excludes1 notes name this code, so the conflict is not listed above.
- G31.84Mild cognitive impairment of uncertain or unknown etiology
- I69Sequelae of cerebrovascular disease
- I69.8Sequelae of other cerebrovascular diseases
- I69.9Sequelae of unspecified cerebrovascular diseases
- P52Intracranial nontraumatic hemorrhage of newborn
- S09.0Injury of blood vessels of head, not elsewhere classified
- S09.0XXAInjury of blood vessels of head, not elsewhere classified, initial encounter
- S09.0XXDInjury of blood vessels of head, not elsewhere classified, subsequent encounter
Risk adjustment
S06.9X5A risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 397 Major Head Injury with Loss of Consciousness > 1 Hour0.199 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
S06.9X5A is named in 8 Medicare coverage policies: 8 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
- A56537Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
- A56612Billing and Coding: CT of the Head
- A56937Billing and Coding: Psychiatry and Psychology Services
Code history
Unchanged in every release from FY2024 to FY2027.