P27.1
BillableBronchopulmonary dysplasia originating in the perinatal period
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P27.1 an HCC code?
Yes. P27.1 maps to Cardio-Respiratory Failure and Shock under the CMS-HCC V28 risk adjustment model.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for P27.1
For P27.1to 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 P27.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P27.1 is the ICD-10-CM diagnosis code for bronchopulmonary dysplasia originating in the perinatal period. A chronic lung disease that develops in premature infants who require prolonged oxygen therapy or mechanical ventilation, characterized by scarring and inflammation of the lungs. P27.1 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering respiratory and cardiovascular disorders specific to the perinatal period (p19-p29).
Under the CMS-HCC V28 risk adjustment model, P27.1 maps to Cardio-Respiratory Failure and Shock (HCC 213) with a community, non-dual, aged base RAF weight of 0.000. P27.1 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.
This code is specific to bronchopulmonary dysplasia (BPD) and should not be used for respiratory conditions in older children or adults. Because P27.1 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 P27.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code is specific to bronchopulmonary dysplasia (BPD) and should not be used for respiratory conditions in older children or adults
- •Document the severity level (mild, moderate, severe) if available, as this may affect treatment and prognosis documentation
Clinical Significance
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in premature infants, resulting from lung injury during critical developmental periods. This condition significantly impacts long-term respiratory health, growth, and neurodevelopmental outcomes, often requiring ongoing respiratory support and specialized care coordination.
Documentation Requirements
- ✓Gestational age at birth (typically <32 weeks)
- ✓Birth weight documentation
- ✓History of mechanical ventilation or oxygen therapy
- ✓Oxygen requirement at 36 weeks corrected gestational age
- ✓Characteristic chest imaging findings
- ✓Duration of respiratory support
- ✓Exclusion of other chronic lung diseases
- ✓Pulmonary function testing if available