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P93.8 ICD-10-CM Code: Other reactions and intoxications due to drugs administered to newborn

P93.8 maps to CMS-HCC V28 137 (RAF 0.424). 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)

P93.8

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other reactions and intoxications due to drugs administered to newborn

A newborn experiences adverse reactions or poisoning from medications given to them, other than grey baby syndrome, such as withdrawal symptoms or toxicity from maternal medications.

Buddy the Bee presenting code insight

Buddy Insight

Other drug reactions and intoxications in newborns encompasses various adverse effects from medications administered to infants beyond grey baby syndrome.

CMS-HCC V28

HCC 137

RAF 0.424

CMS-HCC V24

N/A

—

Not mapped

ACA/HHS

HCC 82

Varies by metal level

ESRD/PACE

N/A

—

Not mapped

RXHCC

N/A

—

Not mapped

Code Book Path

Official
P93Reactions and intoxications due to drugs administered to newborn
P93.8Other reactions and intoxications due to drugs administered to newborn

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for P93.8 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for P93.8 in this effective period.

Related Child Codes

Official
P93.0Grey baby syndrome

Includes

Official
  • reactions and intoxications due to drugs administered to fetus affecting newborn

Excludes 1

Official
  • jaundice due to drugs or toxins transmitted from mother or given to newborn (P58.4-)
  • reactions and intoxications from maternal opiates, tranquilizers and other medication (P04.0-P04.1, P04.4-)
  • withdrawal symptoms from maternal use of drugs of addiction (P96.1)
  • withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for P93.8 in this effective period.

Use Additional

Official
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Code Also

Official

ICD-10-CM does not list Code Also instructions for P93.8 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Clear documentation of adverse drug reaction in newborn
Specific medication causing reaction identified
Clinical signs and symptoms of drug toxicity
Timeline of reaction development after drug administration

MEAT Support

HCC Buddy guidance
Clear documentation of adverse drug reaction in newborn
Specific medication causing reaction identified
Clinical signs and symptoms of drug toxicity
Timeline of reaction development after drug administration

Audit Caution

HCC Buddy guidance
Using grey baby syndrome code for other drug reactions
Confusing drug toxicity with drug withdrawal syndromes
Using adult adverse drug effect codes for neonatal conditions
Missing specific documentation of drug-reaction relationship

Common Mistakes

HCC Buddy guidance
P93.0 — Grey baby syndrome, specific chloramphenicol toxicity
P96.1 — Drug withdrawal from maternal addiction, withdrawal vs toxicity
P96.2 — Withdrawal from therapeutic drugs, withdrawal vs adverse reaction
T88.7 — Unspecified adverse effect of drug, not neonatal-specific

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 P93.8 an HCC code?

Yes. P93.8 (Other reactions and intoxications due to drugs administered to newborn) maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a community non-dual aged RAF of 0.424. It is billable for payment year 2026.

Coder answer: P93.8 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
P93.8
Description
Other reactions and intoxications due to drugs administered to newborn
HCC (V28)
HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF
0.424
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
0.424

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work P93.8 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for P93.8

For P93.8 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 P93.8 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

P93.8 is the ICD-10-CM diagnosis code for other reactions and intoxications due to drugs administered to newborn. A newborn experiences adverse reactions or poisoning from medications given to them, other than grey baby syndrome, such as withdrawal symptoms or toxicity from maternal medications. P93.8 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, P93.8 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. P93.8 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 specify the causative drug using an additional code from the Table of Drugs and Chemicals. Because P93.8 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 P93.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Always specify the causative drug using an additional code from the Table of Drugs and Chemicals
  • •Document the route of administration and timing of medication exposure relative to symptom onset

Clinical Significance

Other drug reactions and intoxications in newborns encompasses various adverse effects from medications administered to infants beyond grey baby syndrome. This diagnosis indicates potential serious drug toxicity requiring immediate evaluation, drug discontinuation, and supportive care management.

Documentation Requirements

  • ✓Clear documentation of adverse drug reaction in newborn
  • ✓Specific medication causing reaction identified
  • ✓Clinical signs and symptoms of drug toxicity
  • ✓Timeline of reaction development after drug administration
  • ✓Dose and duration of drug exposure documented
  • ✓Response to drug discontinuation or dose reduction
  • ✓Supportive care measures provided
  • ✓Outcome and recovery course

Use Additional Code

  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Commonly Confused Codes

  • •P93.0: Grey baby syndrome, specific chloramphenicol toxicity
  • •P96.1: Drug withdrawal from maternal addiction, withdrawal vs toxicity
  • •P96.2: Withdrawal from therapeutic drugs, withdrawal vs adverse reaction
  • •T88.7: Unspecified adverse effect of drug, not neonatal-specific

Child Codes

P93.0Grey baby syndrome
HCC 137
P93.8Other reactions and intoxications due to drugs administered to newborn
HCC 137

Code Hierarchy

└P93Reactions and intoxications due to drugs administered to newborn└P93.8Other reactions and intoxications due to drugs administered to newborn
└P93.8Other reactions and intoxications due to drugs administered to newborn

Because P93.8 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

P93.8 maps to CMS-HCC V28 category 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because P93.8 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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Open P93.8 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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