Q01.8 ICD-10-CM Code: Encephalocele of other sites
Q01.8 maps to CMS-HCC V28 182. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Congenital malformations, deformations and chromosomal abnormalities (Q00-QA0) / Congenital malformations of the nervous system (Q00-Q07)
Q01.8
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceEncephalocele of other sites
A birth defect where brain tissue protrudes through an opening in the skull at a location other than the common sites.
Buddy Insight
Encephaloceles at other sites represent rare variants occurring at atypical skull locations, potentially affecting different brain regions and requiring individualized surgical approaches.
CMS-HCC V28
MappedHCC 182
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 114
Code-level coefficient reference
ESRD/PACE
MappedHCC 72
Code-level coefficient reference
RXHCC
MappedHCC 155
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for Q01.8 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for Q01.8 in this effective period.
Related Child Codes
Includes
Official- Arnold-Chiari syndrome, type III
- encephalocystocele
- encephalomyelocele
- hydroencephalocele
- hydromeningocele, cranial
Excludes 1
Official- Meckel-Gruber syndrome (Q61.9)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for Q01.8 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for Q01.8 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for Q01.8 in this effective period.
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 Q01.8 an HCC code?
Yes. Q01.8 (Encephalocele of other sites) maps to HCC 182, Spinal Cord Disorders/Injuries under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.478. 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: Q01.8 is billable and maps to V28 HCC 182, Spinal Cord Disorders/Injuries. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Q01.8
- Description
- Encephalocele of other sites
- HCC (V28)
- HCC 182 — Spinal Cord Disorders/Injuries
- RAF reference coefficient
- 0.478
- 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 Q01.8 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for Q01.8
For Q01.8 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 Q01.8 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
Q01.8 is the ICD-10-CM diagnosis code for encephalocele of other sites. A birth defect where brain tissue protrudes through an opening in the skull at a location other than the common sites. Q01.8 sits in the ICD-10-CM chapter for congenital malformations, deformations and chromosomal abnormalities (q00-qa0), within the section covering congenital malformations of the nervous system (q00-q07).
Under the CMS-HCC V28 risk adjustment model, Q01.8 maps to Spinal Cord Disorders/Injuries (HCC 182) with a source-labeled community, non-dual, aged reference coefficient of 0.478. No V24 mapping is shown for Q01.8; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.
Use this code only when the encephalocele location doesn't fit Q01.0, Q01.1, or Q01.2. Because Q01.8 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 Q01.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Encephaloceles at other sites represent rare variants occurring at atypical skull locations, potentially affecting different brain regions and requiring individualized surgical approaches. This diagnosis indicates complex neurological malformation requiring specialized neurosurgical evaluation and multidisciplinary care planning.
Documentation Requirements
- ✓Specific anatomical location of encephalocele documented
- ✓Explanation of why location doesn't fit standard classifications
- ✓Size and brain tissue content described
- ✓Associated cranial or facial anomalies
- ✓Neuroimaging findings detailing location and contents
- ✓Surgical feasibility assessment
- ✓Functional implications based on brain tissue involved
- ✓Multidisciplinary team evaluations