Empowering Better Health

e4health tackles data, quality, and revenue challenges empowering your teams to focus on better care.

Our Leaders

Who We Serve



Upcoming Events

Sharing Best Practices

Sharing knowledge, experience, innovations and best practices to help organizations keep pace in the ever-changing healthcare industry.

Case Studies and White Papers

Webinars [Live and On Demand]

CDI and Coding Tips

News & Blog

Taking care of the business and quality of healthcare

e4health cares for the quality, data, and results of your healthcare, so that you can care for your patients.

Health IT Consulting

Enterprise Program Management and Governance

Legacy Data Migration and Validation

Legacy System Support

IT and Project Team Staffing

Clinical Informatics Solutions

Data Analytics

Testing Management and Coordination

Go-Live Support

Mid-Revenue Cycle


Risk Adjustment and HCCs

Education and Training

Health Information Management

eMPI Remediation and Ongoing Management

Clinical Data Abstraction

Legacy Data Migration and Validation

Document Management

Interim Leadership and Staffing


Software Solutions

AI and Automation Solutions
CDI Tips & Friendly Reminders: Cerebral Edema & Brain Compression

Cerebral Edema & Brain Compression

Cerebral Edema Definition: Swelling of the brain. Can result from a variety of derangements that can stem from trauma, hypoxia, infection, CVA, intracerebral hemorrhage, metabolic derangements, hepatitis, Reye syndrome, carbon monoxide poisoning, lead poisoning, high altitude, acute hypertension, or tumors

Brain Compression Definition: Increased pressure pushing on the brain causing displacement that can lead to herniation.

Brain Herniation Definition: Occurs when increased intracranial pressure causes abnormal protrusion of brain tissue through openings in rigid intracranial barriers (tentorial notch, falx cerebri, foramen magnum). Classified based on the structure through which tissue is herniated. Types include: transtentorial (uncal), subfalcine, central, upward transtentorial or tonsillar. Common etiologies include, but are not limited to, traumatic epidural/subdural hematoma, malignant infarction, tumors, infections, hydrocephalus, diffuse subarachnoid hemorrhage, pneumocephalus (traumatic or postoperative), CSF over drainage, metabolic-hepatic encephalopathy, contusion, or intracerebral hemorrhage. 


Diagnostic Criteria

  • Brain CT and/or MRI will confirm the presence of cerebral edema, compression, and/or herniation. 
  • Brain herniation signs/symptoms can be more pronounced depending on the degree of herniation.  
  • Cerebral edema can be asymptomatic, only seen on imaging, or cause life-threatening complications, varying widely depending on the location/extent of the cerebral edema.  
  • Signs and symptoms can include visual disturbances, seizures, sensory changes, diplopia, headaches, N/V, lethargy, AMS/confusion, respiratory irregularities, fixed unequal pupils, ataxia to abnormal posturing, coma and even death. 

Coding Considerations

Review pertinent Coding Clinics such as:

  • AHA Coding Clinic Fourth Quarter 2021, p. 29 ICD-10-CM New/Revised Codes: Traumatic Brain Compression and Herniation 
  • AHA Coding Clinic Second Quarter 2020, p. 31 Traumatic Brain Injury with Herniation 
  • AHA Coding Clinic Fourth Quarter 2022, p. 42 New/Revised ICD-10-CM Codes: Intracranial Injury with Unknown Loss of Consciousness 
  • AHA Coding Clinic Third Quarter 2022, p. 9 Lung and Brain Metastases, Intracerebral hemorrhage, and Vasogenic Cerebral Edema 
  • AHA Coding Clinic Third Quarter 2022, p. 10 Vasogenic Cerebral Edema and Breast Cancer with Brain Metastases 

An Excludes1 note identifies cerebral edema due to birth injury (P11.0) and traumatic cerebral edema (S06.1-) cannot be coded with Cerebral edema (G93.6) 

Inclusion terms for Traumatic cerebral edema include diffuse traumatic cerebral edema and focal traumatic cerebral edema. 

ICD-10-CM identifies traumatic cerebral edema based on loss of consciousness, then duration. When the 7th character is identified as A, initial encounter, these codes are designated as MCC’s. Note: 7th characters D and S do not apply to codes in category S06 with 6th character 7-death due to brain injury prior to regaining consciousness, or 8-death due to other cause prior to regaining consciousness.  

An Excludes1 note identifies that traumatic compression of the brain (S06.A-) cannot be coded with Compression of the brain (G93.5)

Inclusion terms for Compression of the brain include Arnold-Chiari type 1 compression of brain, Compression of brain (stem), and Herniation of brain (stem). 

CD-10-CM identifies traumatic brain compression as with (S06A1-) or without herniation (S06.A0-). When the 6th character is identified as A, initial encounter, these codes are designated as MCC’s. Category S06.A codes have a Code First notation for the underlying traumatic brain injury, such as:

  • Diffuse traumatic brain injury (S06.2-) 
  • Focal traumatic brain injury (S06.3-) 
  • Traumatic subdural hemorrhage (S06.5-) 
  • Traumatic subarachnoid hemorrhage (S06.6-) 

Several category S06 codes as well as G96.6 and G96.5 map to HCCs and can affect Risk Adjustment scores. 


CDI Practice Considerations

  • Review documentation (including CT/MRI findings) for the underlying etiology, first noting if the cause is due to trauma, then further noting the underlying root origin of the original insult causing of the cerebral edema, brain compression or herniation, querying when necessary. 
  • Clinically validating the presence of Cerebral Edema and Brain Compression is common for mitigating denials as they are typically MCCs impacting MS-DRG assignment. Minor localized edema surrounding a lesion identified on CT or MRI can be an intrinsic finding associated with the underlying etiology. Ensure the cerebral edema is clinically significant or identified as generalized brain swelling and meet the definition of a secondary diagnosis per ICD-10-CM Official Coding Guidelines, querying when necessary. Note: It is inappropriate to report an incidental finding found on a radiology report when the finding is unrelated to the sign, symptom, or condition that caused the performance of the test. The provider would need to clarify that the finding was clinically significant and related to the visit for it to be coded. 
  • Review for related comorbidities such as Coma, Brain Death, Sepsis, Acute Hypoxic Respiratory Failure, AKI, and other body system failures. 
  • Terms that indicate brain compression that require a query to clarify, if clinically significant, include ventricular effacement, sulcal effacement; cisternal effacement, uncal deviation, shift of midline structures and mass effect. 
  • Treatment for cerebral edema and brain compression/herniation will focus on preventing further injury and direct towards the underlying etiology, attempting to remediate  
  • Cerebral Edema, Brain Compression, and Brain Herniation are not considered integral to many nontraumatic brain diseases/disorders or traumatic brain injuries. Therefore, review the record closely for clinical indicator support and query when necessary. Capturing these diagnoses as comorbidities will accurately reflect the patient’s complexity and severity in the coded data and may impact MS-DRG assignment. 
  • Examine nursing assessments closely when reviewing clinical indicator support, specifically noting Glasgow Coma Scale (GCS) scores, National Institute of Health Stroke Scale (NIHSS) scores and, if applicable, Intracranial Pressure (ICP) monitoring 


Looking for CDI help?

Learn more about e4health CDI Solutions. Our Team is leading the way in the CDI industry.

e4health CDI Education

Need help to earn CEUs or education your team? Visit the IQ Education Center and get your free account or contact us for more information. e4health is dedicated to elevating the business of healthcare. We are committed to offering support and the most current information and updates to collaborate with coding and CDI professionals to realize their fullest potential. We enthusiastically seek opportunities to develop ourselves and each other. We understand that knowledge is the key to success for our clients navigating the ever-changing health information management landscape.
Screenshot 2024 05 16 102535

Earn FREE ACDIS CEUs when you join Staci Josten, RN, BSN, CCDS, Alyson Swinehart, BSN, RN, CCDS, and other CDI leaders for a roundtable discussion regarding important, timely industry topics! The topic for June’s discussion is: Advancing your CDI Program with Quality Assurance & CDI Audits. We will provide background on this topic, share industry insights, and facilitate collaborative discussion with guided questions and answers.

Click here to register!


Learning Objectives:

  • Understand the value CDI quality assurance and audits provide
  • Identify CDI query opportunities to include in quality assurance or audit parameters
  • Define “CDI query compliance strategies to incorporate into quality assurance or audit parameters

What is the e4health CDI Leadership Roundtable?
The goal for the virtual CDI Leadership Roundtable Discussion is for CDI leaders to explore specific topics within CDI, learn about the topic and from each other. During each roundtable, e4health CDI Leader’s will present a CDI topic, spend time sharing current industry standards or some education regarding this topic and then open with probing questions for group discussion.

Who should attend the e4health CDI Leadership Roundtable?
The focus of this group is for those who have influence over CDI program process, policy, and education.

Why should I attend the e4health CDI Roundtable?
This will be a wonderful place to learn, share your wins and challenges and collaborate with other CDI leaders across the industry. Also, after completing a survey, free ACDIS CEUs will be earned.

  The information and opinions presented here are based on the experience, training, and interpretation of e4health. Although the information has been researched and reviewed for accuracy, e4health does not accept any responsibility or liability regarding errors, omissions, misuse, or misinterpretation. This information is intended as a guide; it should not be considered a legal/consulting opinion or advice.