P78.0
BillablePerinatal intestinal perforation
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P78.0 an HCC code?
Yes. P78.0 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 P78.0
For P78.0 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 P78.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P78.0 is the ICD-10-CM diagnosis code for perinatal intestinal perforation. A hole or tear in the newborn's intestines that occurs during the perinatal period, allowing intestinal contents to leak into the abdominal cavity. P78.0 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, P78.0 maps to Intestinal Obstruction/Perforation (HCC 78) with a community, non-dual, aged base RAF weight of 0.000. P78.0 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.
Document the location and cause of perforation when possible; this may be related to NEC, meconium ileus, or other conditions. Because P78.0 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 P78.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the location and cause of perforation when possible; this may be related to NEC, meconium ileus, or other conditions
- •Code any resulting peritonitis or sepsis separately; ensure this code is not used if perforation is secondary to NEC (use P77.3 instead)
Clinical Significance
Perinatal intestinal perforation is a critical neonatal condition requiring immediate surgical intervention and intensive monitoring. This diagnosis represents significant morbidity risk and potential long-term complications affecting the newborn's digestive system and overall health outcomes.
Documentation Requirements
- ✓Clear documentation of intestinal perforation diagnosed during perinatal period
- ✓Evidence of hole or tear in intestinal wall allowing contents to leak
- ✓Documentation of clinical signs such as abdominal distension or peritonitis
- ✓Imaging studies confirming perforation (X-ray, ultrasound, or CT findings)
- ✓Surgical findings if operative intervention performed
- ✓Timing of perforation occurrence (during delivery, immediately postpartum, etc.)
- ✓Associated complications such as peritonitis or sepsis
- ✓Response to treatment and clinical course