P77.1
BillableStage 1 necrotizing enterocolitis in newborn
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P77.1 an HCC code?
Yes. P77.1 maps to Intestinal Obstruction/Perforation 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 P77.1
For P77.1 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 P77.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P77.1 is the ICD-10-CM diagnosis code for stage 1 necrotizing enterocolitis in newborn. Early stage necrotizing enterocolitis in a newborn, characterized by initial signs of intestinal inflammation without perforation. P77.1 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering digestive system disorders of newborn (p76-p78).
Under the CMS-HCC V28 risk adjustment model, P77.1 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.000. P77.1 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.
Stage 1 NEC is the mildest form; document clinical findings such as feeding intolerance, abdominal distension, or bloody stools to support the diagnosis. Because P77.1 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 P77.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Stage 1 NEC is the mildest form; document clinical findings such as feeding intolerance, abdominal distension, or bloody stools to support the diagnosis
- •Differentiate from Stage 2 and 3 by confirming absence of pneumatosis intestinalis or perforation on imaging
Clinical Significance
Stage 1 NEC represents the earliest identifiable phase of this serious neonatal condition that can progress rapidly to more severe stages requiring surgical intervention. Early recognition and staging are crucial for appropriate treatment decisions and monitoring for disease progression in vulnerable neonates.
Documentation Requirements
- ✓Gestational age and birth weight of the newborn
- ✓Clinical signs consistent with Stage 1 NEC (feeding intolerance, gastric residuals)
- ✓Radiographic findings showing normal or mildly abnormal bowel gas pattern
- ✓Absence of pneumatosis intestinalis or portal venous gas
- ✓Documentation of staging criteria used
- ✓Treatment interventions implemented (NPO status, antibiotics)
- ✓Monitoring parameters and frequency
- ✓Risk factors present (prematurity, formula feeding)
Commonly Confused Codes
- •P77.2 — Stage 2 necrotizing enterocolitis (has pneumatosis intestinalis on imaging)
- •P77.3 — Stage 3 necrotizing enterocolitis (has perforation and peritonitis)
- •P77.9 — Necrotizing enterocolitis, unspecified (stage not documented)
- •P76.0 — Meconium plug syndrome (mechanical obstruction, not inflammatory)