P93.8
BillableOther reactions and intoxications due to drugs administered to newborn
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is P93.8 an HCC code?
Yes. P93.8 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 P93.8
For P93.8to 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.
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