P10.9
BillableUnspecified intracranial laceration and hemorrhage due to birth injury
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P10.9 an HCC code?
Yes. P10.9 maps to Cerebral Hemorrhage under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for P10.9
For P10.9 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed P10.9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P10.9 is the ICD-10-CM diagnosis code for unspecified intracranial laceration and hemorrhage due to birth injury. Brain bleeding or cuts from birth injury when the specific type or location is not documented or specified. P10.9 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, P10.9 maps to Cerebral Hemorrhage (HCC 248) with a community, non-dual, aged base RAF weight of 0.289. P10.9 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This is a default code; attempt to obtain more specific documentation before using this unspecified code. Because P10.9 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for P10.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; attempt to obtain more specific documentation before using this unspecified code
- •Query the provider if imaging or clinical findings suggest a more specific diagnosis
Clinical Significance
Unspecified intracranial injury from birth trauma represents brain damage of undetermined type that occurred during delivery, requiring intensive neonatal monitoring and assessment. While less specific than other codes, it still indicates significant birth complications that can impact neurological development and long-term outcomes.
Documentation Requirements
- ✓Evidence of intracranial injury from birth trauma
- ✓Documentation that injury type cannot be further specified
- ✓Imaging studies showing brain abnormalities
- ✓Birth complications or traumatic delivery documentation
- ✓Neurological examination findings
- ✓Exclusion of more specific injury types
- ✓Monitoring protocols for neurological complications
- ✓Plans for developmental follow-up and assessment