P11.1 ICD-10-CM Code: Other specified brain damage due to birth injury

Coder workflow for P11.1

MedCoder structured workflow — derived from this code’s own official record

Before you code P11.1

1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on P11.1; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

   ReviewP11.0, P11.3, P11.4, P11.5

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

2. P11.1’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

   Guide: Combination codes →

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

The associated condition or complication

Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (5)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Birth, injury NOS, basal ganglia
• Birth, injury NOS, cerebellum
• Birth, injury NOS, meninges, brain
• Encephalopathy (acute), in (due to) (with), birth injury
• Pressure, brain, injury at birth NEC

Don’t confuse P11.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of P11.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• P11.2— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Unspecified brain damage due to birth injury” takes P11.2; specificity in the record moves it back here.

  Full comparison: P11.1 vs P11.2 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 794 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PNL008 — Birth trauma (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Intracranial Hemorrhage) for risk-adjusted payment.

I62.1 — Nontraumatic extradural hemorrhage, I62.9 — Nontraumatic intracranial hemorrhage, unspecified, P10.0 — Subdural hemorrhage due to birth injury, P10.1 — Cerebral hemorrhage due to birth injury, P10.2 — Intraventricular hemorrhage due to birth injury, P10.3 — Subarachnoid hemorrhage due to birth injury, P10.4 — Tentorial tear due to birth injury, P10.8 — Other intracranial lacerations and hemorrhages due to birth injury, P10.9 — Unspecified intracranial laceration and hemorrhage due to birth injury, P11.0 — Cerebral edema due to birth injury, P11.2 — Unspecified brain damage due to birth injury, P52.0 — Intraventricular (nontraumatic) hemorrhage, grade 1, of newborn, P52.1 — Intraventricular (nontraumatic) hemorrhage, grade 2, of newborn, P52.21 — Intraventricular (nontraumatic) hemorrhage, grade 3, of newborn, P52.22 — Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn, P52.3 — Unspecified intraventricular (nontraumatic) hemorrhage of newborn, P52.4 — Intracerebral (nontraumatic) hemorrhage of newborn, P52.5 — Subarachnoid (nontraumatic) hemorrhage of newborn, P52.6 — Cerebellar (nontraumatic) and posterior fossa hemorrhage of newborn, P52.8 — Other intracranial (nontraumatic) hemorrhages of newborn, +32 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Ischemic or Unspecified Stroke

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Birth trauma).

P10.0 — Subdural hemorrhage due to birth injury, P10.1 — Cerebral hemorrhage due to birth injury, P10.2 — Intraventricular hemorrhage due to birth injury, P10.3 — Subarachnoid hemorrhage due to birth injury, P10.4 — Tentorial tear due to birth injury, P10.8 — Other intracranial lacerations and hemorrhages due to birth injury, P10.9 — Unspecified intracranial laceration and hemorrhage due to birth injury, P11.0 — Cerebral edema due to birth injury, P11.2 — Unspecified brain damage due to birth injury, P11.3 — Birth injury to facial nerve, P11.4 — Birth injury to other cranial nerves, P11.5 — Birth injury to spine and spinal cord, P11.9 — Birth injury to central nervous system, unspecified, P12.0 — Cephalhematoma due to birth injury, P12.1 — Chignon (from vacuum extraction) due to birth injury, P12.2 — Epicranial subaponeurotic hemorrhage due to birth injury, P12.3 — Bruising of scalp due to birth injury, P12.4 — Injury of scalp of newborn due to monitoring equipment, P12.81 — Caput succedaneum, P12.89 — Other birth injuries to scalp, +23 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Birth”, “Encephalopathy”, “Pressure”; these codes share that main term but sit in a different category of the Tabular List.

K76.82 — Hepatic encephalopathy (hepatic), P08.0 — Exceptionally large newborn baby (weight, 4500 grams or more), P08.1 — Other heavy for gestational age newborn (weight, 4000 grams to 4499 grams), P10.0 — Subdural hemorrhage due to birth injury (injury NOS, subdural hemorrhage), P10.1 — Cerebral hemorrhage due to birth injury (injury NOS, laceration, brain), P10.2 — Intraventricular hemorrhage due to birth injury (injury NOS, intraventricular hemorrhage), P10.3 — Subarachnoid hemorrhage due to birth injury (injury NOS, subarachnoid hemorrhage), P10.4 — Tentorial tear due to birth injury (injury NOS, tentorial tear), P10.8 — Other intracranial lacerations and hemorrhages due to birth injury (injury NOS, intracranial, laceration or hemorrhage, specified NEC), P10.9 — Unspecified intracranial laceration and hemorrhage due to birth injury (injury NOS, intracranial, laceration or hemorrhage), P12.9 — Birth injury to scalp, unspecified (injury NOS, scalp), P13.0 — Fracture of skull due to birth injury (injury NOS, fracture, skull), P13.1 — Other birth injuries to skull (injury NOS, skull NEC), P13.2 — Birth injury to femur (injury NOS, fracture, femur), P13.3 — Birth injury to other long bones (injury NOS, fracture, humerus), P13.4 — Fracture of clavicle due to birth injury (injury NOS, fracture, clavicle), P13.8 — Birth injuries to other parts of skeleton (injury NOS, fracture, bone, specified NEC), P13.9 — Birth injury to skeleton, unspecified (injury NOS, fracture, bone), P14.2 — Phrenic nerve paralysis due to birth injury (injury NOS, nerve, phrenic), P14.3 — Other brachial plexus birth injuries (injury NOS, brachial plexus NEC), +62 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of P11.1 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

• P00-P96 — Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96) (P00-P96)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P10-P15 — Birth trauma[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Clinical classification (CCSR)

• PNL008 — Birth trauma[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 248 — Intracranial Hemorrhage [CMS-HCC]: “Intracranial Hemorrhage — supersedes HCC 249 (Ischemic or Unspecified Stroke)”— CMS-HCC V28 · 2026

MS-DRG Grouper

• DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS[MS-DRG]: “NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Birth, injury NOS, basal ganglia[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Birth, injury NOS, cerebellum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Birth, injury NOS, meninges, brain[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Encephalopathy (acute), in (due to) (with), birth injury[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Pressure, brain, injury at birth NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• P11 — Other birth injuries to central nervous system[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.0 — Cerebral edema due to birth injury[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.2 — Unspecified brain damage due to birth injury[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.3 — Birth injury to facial nerve[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.4 — Birth injury to other cranial nerves[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.5 — Birth injury to spine and spinal cord[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P11.9 — Birth injury to central nervous system, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P11.1 in its code family, with their registry titles.

• P11 — Other birth injuries to central nervous system
• P11.0 — Cerebral edema due to birth injury
• P11.2 — Unspecified brain damage due to birth injury
• P11.3 — Birth injury to facial nerve
• P11.4 — Birth injury to other cranial nerves
• P11.5 — Birth injury to spine and spinal cord
• P11.9 — Birth injury to central nervous system, unspecified

View all codes in the P11 family