What is ICD-10 code P11.0?

P11.0 is the ICD-10-CM diagnosis code for Cerebral edema due to birth injury. Swelling of the brain tissue that develops as a result of birth trauma. It belongs to the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96). P11.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. P11.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. P11.0 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. P11.0 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for P11.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. P11.0 is a payment HCC under V28 (Intracranial Hemorrhage) but was not retained as a payment HCC under V24. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting P11.0?

Document the timing of edema onset and any imaging findings (CT or MRI) that confirm the diagnosis This condition may develop hours to days after birth, so review the clinical timeline carefully Because P11.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM P11.0: Cerebral edema due to birth

ICD-10-CM Code View

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Code lookupP11.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Birth trauma (P10-P15)

P11.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Cerebral edema due to birth injury

Swelling of the brain tissue that develops as a result of birth trauma.

Buddy Insight

Cerebral edema from birth injury represents brain swelling following delivery trauma, which can lead to increased intracranial pressure and neurological complications.

CMS-HCC V28

Mapped

HCC 248

Intracranial Hemorrhage

RAF 0.239

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

Mapped

HCC 145

HHS-HCC 145

Varies by metal level

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

P11Other birth injuries to central nervous system

P11.0Cerebral edema due to birth injury

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for P11.0 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for P11.0 in this effective period.

Related Child Codes

Official

P11.1Other specified brain damage due to birth injury

P11.2Unspecified brain damage due to birth injury

P11.3Birth injury to facial nerve

P11.4Birth injury to other cranial nerves

P11.5Birth injury to spine and spinal cord

Includes

Official

ICD-10-CM does not list Includes notes for P11.0 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for P11.0 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for P11.0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for P11.0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for P11.0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Imaging evidence of cerebral swelling or edema

Documentation of birth trauma as causative factor

Assessment of intracranial pressure signs and symptoms

Neurological examination and status documentation

MEAT Support

HCC Buddy guidance

Imaging evidence of cerebral swelling or edema

Documentation of birth trauma as causative factor

Assessment of intracranial pressure signs and symptoms

Neurological examination and status documentation

Audit Caution

HCC Buddy guidance

Confusing traumatic edema with hypoxic-ischemic injury

Missing birth trauma documentation as etiology

Failing to distinguish from other causes of neonatal brain swelling

Not documenting imaging findings supporting edema diagnosis

Common Mistakes

HCC Buddy guidance

P91.60 — Hypoxic ischemic encephalopathy (hypoxic vs traumatic edema)

G93.1 — Anoxic brain damage (adult condition vs neonatal trauma)

P10.2 — Intraventricular hemorrhage due to birth injury (bleeding vs edema)

P91.4 — Neonatal cerebral depression (depression vs edema)

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 P11.0 an HCC code?

Yes. P11.0 (Cerebral edema due to birth injury) maps to Intracranial Hemorrhage under the CMS-HCC V28 risk adjustment model, with a community non-dual aged RAF of 0.239. It is billable for payment year 2026.

Coder answer: P11.0 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: P11.0
Description: Cerebral edema due to birth injury
HCC (V28): HCC 248 — Intracranial Hemorrhage
RAF: 0.239
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 248, Intracranial Hemorrhage

0.239

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work P11.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for P11.0

For P11.0 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 P11.0 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

P11.0 is the ICD-10-CM diagnosis code for cerebral edema due to birth injury. Swelling of the brain tissue that develops as a result of birth trauma. P11.0 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, P11.0 maps to Intracranial Hemorrhage (HCC 248) with a community, non-dual, aged base RAF weight of 0.239. P11.0 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.

Document the timing of edema onset and any imaging findings (CT or MRI) that confirm the diagnosis. Because P11.0 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 P11.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the timing of edema onset and any imaging findings (CT or MRI) that confirm the diagnosis
•This condition may develop hours to days after birth, so review the clinical timeline carefully

Clinical Significance

Cerebral edema from birth injury represents brain swelling following delivery trauma, which can lead to increased intracranial pressure and neurological complications. This condition requires intensive neonatal monitoring and may indicate severe birth trauma with potential for long-term neurological sequelae.