P10.4 ICD-10-CM Code: Tentorial tear due to birth injury
P10.4 maps to CMS-HCC V28 248. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Birth trauma (P10-P15)
P10.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceTentorial tear due to birth injury
A tear in the tentorial membrane (the tissue that separates the upper and lower brain) caused by birth trauma.
Buddy Insight
Tentorial tear represents severe birth trauma affecting the membrane separating cerebrum and cerebellum, often associated with difficult deliveries and can lead to significant intracranial bleeding and increased intracranial pressure.
CMS-HCC V28
MappedHCC 248
Coefficient HCC 248: 0.239 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 145
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for P10.4. Check the code and parent instructions in the Code Book.
Excludes 2
Official- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from P00-P96
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from P00-P96
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from P00-P96
- neoplasms (C00-D49)Inherited from P00-P96
- tetanus neonatorum (A33)Inherited from P00-P96
Related Codes
Includes
Official- conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs laterInherited from P00-P96
Excludes 1
Official- intracranial hemorrhage of newborn NOS (P52.9)Inherited from P10
- intracranial hemorrhage of newborn due to anoxia or hypoxia (P52.-)Inherited from P10
- nontraumatic intracranial hemorrhage of newborn (P52.-)Inherited from P10
Code First
OfficialNo Code First sequencing instructions are included in this display for P10.4. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for P10.4. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for P10.4. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is P10.4 an HCC code?
Yes. P10.4 (Tentorial tear due to birth injury) maps to HCC 248, Intracranial Hemorrhage under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.239. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: P10.4 is billable and maps to V28 HCC 248, Intracranial Hemorrhage. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- P10.4
- Description
- Tentorial tear due to birth injury
- HCC (V28)
- HCC 248 — Intracranial Hemorrhage
- RAF reference coefficient
- 0.239
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work P10.4 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for P10.4
For P10.4, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
P10.4 is the ICD-10-CM diagnosis code for tentorial tear due to birth injury. A tear in the tentorial membrane (the tissue that separates the upper and lower brain) caused by birth trauma. P10.4 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering birth trauma (p10-p15).
Under the CMS-HCC V28 risk adjustment model, P10.4 maps to Intracranial Hemorrhage (HCC 248) with a source-labeled community, non-dual, aged reference coefficient of 0.239. No V24 mapping is shown for P10.4; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This is a serious birth injury often associated with difficult or instrumented deliveries. For P10.4, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for P10.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a serious birth injury often associated with difficult or instrumented deliveries
- •Document the delivery method and any complications that led to this injury
Clinical Significance
Tentorial tear represents severe birth trauma affecting the membrane separating cerebrum and cerebellum, often associated with difficult deliveries and can lead to significant intracranial bleeding and increased intracranial pressure. This condition carries high risk for neurological complications and requires intensive monitoring.
Documentation Requirements
- ✓Imaging confirmation of tentorial membrane tear
- ✓Documentation of traumatic delivery or birth complications
- ✓Assessment of associated intracranial bleeding
- ✓Neurological examination and status documentation
- ✓Evidence of difficult delivery, large birth weight, or instrumental delivery
- ✓Monitoring for signs of increased intracranial pressure
- ✓Associated complications such as herniation or hydrocephalus
- ✓Neurosurgical consultation and intervention if needed
Commonly Confused Codes
- •P10.1: Subdural hemorrhage due to birth injury (bleeding vs structural tear)
- •P10.8: Other intracranial lacerations due to birth injury (non-specific tears)
- •P52.4: Intracerebral hemorrhage (bleeding within brain tissue)
- •P11.2: Unspecified brain damage due to birth injury (non-specific injury)
- •G93.1: Anoxic brain damage (hypoxic vs mechanical trauma)