P93.0
BillableGrey baby syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P93.0 an HCC code?
Yes. P93.0 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications 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 P93.0
For P93.0to 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 P93.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
P93.0 is the ICD-10-CM diagnosis code for grey baby syndrome. A rare and serious condition where a newborn develops a bluish-gray skin discoloration and other symptoms due to certain medications, particularly chloramphenicol, given during pregnancy or after birth. P93.0 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, P93.0 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a community, non-dual, aged base RAF weight of 0.424. P93.0 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.
This is a rare adverse drug reaction; always document the specific medication that caused the condition. Because P93.0 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 P93.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a rare adverse drug reaction; always document the specific medication that caused the condition
- •Verify the medication history and timing of administration to confirm this diagnosis
Clinical Significance
Grey baby syndrome is a rare but serious toxic reaction in newborns, typically from chloramphenicol exposure, characterized by cardiovascular collapse and distinctive skin discoloration. This diagnosis indicates life-threatening drug toxicity requiring immediate discontinuation of causative medication and intensive supportive care.
Documentation Requirements
- ✓Documentation of characteristic grey or blue-grey skin discoloration
- ✓History of chloramphenicol or other causative drug exposure
- ✓Associated symptoms (vomiting, abdominal distension, cardiovascular collapse)
- ✓Timeline of symptom development after drug exposure
- ✓Laboratory findings supporting diagnosis if available
- ✓Response to drug discontinuation
- ✓Supportive care measures provided
- ✓Outcome and recovery documentation