P28.11
BillableResorption atelectasis without respiratory distress syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P28.11 an HCC code?
Yes. P28.11 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 P28.11
For P28.11 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 P28.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P28.11 is the ICD-10-CM diagnosis code for resorption atelectasis without respiratory distress syndrome. Collapsed lung tissue in a newborn caused by absorption of air from the alveoli, occurring without respiratory distress syndrome. P28.11 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, P28.11 maps to Cardio-Respiratory Failure and Shock (HCC 213) with a community, non-dual, aged base RAF weight of 0.000. P28.11 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 specifically excludes cases with respiratory distress syndrome; verify the absence of RDS in the documentation. Because P28.11 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 P28.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code specifically excludes cases with respiratory distress syndrome; verify the absence of RDS in the documentation
- •Resorption atelectasis is typically caused by airway obstruction or inadequate ventilation
Clinical Significance
Resorption atelectasis without RDS represents lung collapse caused by absorption of trapped air from alveoli, occurring independently of respiratory distress syndrome. This condition requires careful respiratory management and monitoring to prevent complications such as pneumonia or persistent respiratory insufficiency in vulnerable newborns.
Documentation Requirements
- ✓Evidence of resorption-type atelectasis mechanism
- ✓Confirmation that RDS is not present
- ✓Chest imaging showing characteristic patterns
- ✓Gestational age and birth weight
- ✓Clinical presentation consistent with resorption
- ✓Exclusion of respiratory distress syndrome
- ✓Respiratory support requirements
- ✓Treatment response documentation
Excludes 1 — Do NOT code together
- resorption atelectasis with respiratory distress syndrome (P22.0)