Q01.2

Billable

Occipital encephalocele

HCC Category Mapping

V28HCC 182 — Spinal Cord Disorders/Injuries

0.282

V24HCC 72 — Spinal Cord Disorders/Injuries

0.464

ESRDHCC 72 — Spinal Cord Disorders/Injuries

0.000

RxHCCHCC 155 — Myelitis and Encephalomyelitis

0.000

What This Code Means

A birth defect where brain tissue bulges through an opening in the back of the skull.

Coding Tips

•Occipital encephaloceles are the most common type; document size and neurological involvement
•Note whether the defect is covered by skin or exposed

Clinical Significance

Occipital encephalocele represents the most common type of encephalocele with brain tissue protruding through the back of the skull, often associated with hydrocephalus and developmental delays. This diagnosis indicates significant neurological risk requiring neurosurgical evaluation and long-term developmental monitoring.

Documentation Requirements

✓Clear documentation of occipital location of encephalocele
✓Size and contents of protruding sac documented
✓Associated hydrocephalus presence or absence
✓Neuroimaging findings showing brain tissue involvement
✓Neurological examination and developmental assessment
✓Surgical evaluation and treatment planning
✓Associated posterior fossa abnormalities
✓Visual field testing if age appropriate

Commonly Confused Codes

Q01.0 — Frontal encephalocele, front vs back of head Q01.1 — Nasofrontal encephalocele, involves nose and forehead Q03.9 — Congenital hydrocephalus, may be associated but separate Q01.9 — Encephalocele unspecified, when occipital location documented

Code Hierarchy

└Q01Encephalocele └Q01.2Occipital encephalocele

└Q01.2Occipital encephalocele