P90
BillableConvulsions of newborn
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P90 an HCC code?
Yes. P90 maps to Seizure Disorders and Convulsions 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 P90
For P90to 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 P90 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P90 is the ICD-10-CM diagnosis code for convulsions of newborn. Seizures or convulsive episodes occurring in newborns, which may be caused by various conditions such as infection, metabolic issues, or birth trauma. P90 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering other disorders originating in the perinatal period (p90-p96).
Under the CMS-HCC V28 risk adjustment model, P90 maps to Seizure Disorders and Convulsions (HCC 201) with a community, non-dual, aged base RAF weight of 0.262. P90 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.
Always investigate and document the underlying cause of neonatal seizures, as this may require additional coding. Because P90 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 P90 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always investigate and document the underlying cause of neonatal seizures, as this may require additional coding
- •Distinguish between true seizures and benign sleep myoclonus or jitteriness, which are not coded as convulsions
Clinical Significance
Neonatal convulsions represent serious neurological complications requiring immediate evaluation and treatment. This diagnosis indicates significant risk for developmental delays, cerebral palsy, and long-term neurological sequelae affecting the infant's prognosis.
Documentation Requirements
- ✓Clear documentation of seizure activity or convulsions in newborn
- ✓Description of seizure type and characteristics observed
- ✓EEG findings if performed to confirm seizure activity
- ✓Underlying etiology identified (hypoxia, infection, metabolic, etc.)
- ✓Response to anticonvulsant therapy if administered
- ✓Neurological examination findings
- ✓Associated complications such as respiratory compromise
- ✓Follow-up neurological assessments and outcomes
Excludes 1 — Do NOT code together
Commonly Confused Codes
- •G40.9 — Epilepsy unspecified, for established seizure disorders beyond neonatal period
- •P91.4 — Neonatal cerebral depression, decreased responsiveness without seizures
- •R56.9 — Unspecified convulsions, not neonatal-specific
- •P91.3 — Neonatal cerebral irritability, hyperexcitability without frank seizures