P91.88 ICD-10-CM Code: Other specified disturbances of cerebral status of newborn
P91.88 maps to CMS-HCC V28 202. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Other disorders originating in the perinatal period (P90-P96)
P91.88
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified disturbances of cerebral status of newborn
A newborn experiencing specific identified problems with brain function or consciousness, such as irritability, lethargy, or other neurological disturbances beyond the more common conditions.
Buddy Insight
Other specified disturbances of cerebral status encompasses various identified neurological problems in newborns not covered by more specific codes.
CMS-HCC V28
MappedHCC 202
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 122
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for P91.88 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for P91.88 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for P91.88 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for P91.88 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for P91.88 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for P91.88 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for P91.88 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is P91.88 an HCC code?
Yes. P91.88 (Other specified disturbances of cerebral status of newborn) maps to HCC 202, Coma, Brain Compression/Anoxic Damage under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.543. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: P91.88 is billable and maps to V28 HCC 202, Coma, Brain Compression/Anoxic Damage. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- P91.88
- Description
- Other specified disturbances of cerebral status of newborn
- HCC (V28)
- HCC 202 — Coma, Brain Compression/Anoxic Damage
- RAF reference coefficient
- 0.543
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work P91.88 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for P91.88
For P91.88 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 P91.88 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
P91.88 is the ICD-10-CM diagnosis code for other specified disturbances of cerebral status of newborn. A newborn experiencing specific identified problems with brain function or consciousness, such as irritability, lethargy, or other neurological disturbances beyond the more common conditions. P91.88 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, P91.88 maps to Coma, Brain Compression/Anoxic Damage (HCC 202) with a source-labeled community, non-dual, aged reference coefficient of 0.543. No V24 mapping is shown for P91.88; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code when a specific cerebral disturbance is documented but doesn't fit other P91 categories; always document the specific condition observed. Because P91.88 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for P91.88 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Other specified disturbances of cerebral status encompasses various identified neurological problems in newborns not covered by more specific codes. This diagnosis indicates documented brain dysfunction requiring specialized evaluation and monitoring for neurodevelopmental outcomes.
Documentation Requirements
- ✓Clear documentation of specific cerebral disturbance not covered by other P91 codes
- ✓Detailed description of neurological abnormalities present
- ✓Clinical examination findings supporting cerebral dysfunction
- ✓Diagnostic studies performed to characterize disturbance
- ✓Underlying etiology identified if possible
- ✓Response to interventions or treatments
- ✓Impact on feeding, behavior, or development
- ✓Follow-up plans for neurological monitoring