Q93.81
BillableVelo-cardio-facial syndrome
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q93.81 an HCC code?
No. Q93.81 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 Q93.81
For Q93.81to 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 Q93.81 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Q93.81 is the ICD-10-CM diagnosis code for velo-cardio-facial syndrome. Velo-cardio-facial syndrome (also called DiGeorge syndrome or 22q11 deletion syndrome) is a genetic disorder caused by a small deletion on chromosome 22, characterized by heart defects, cleft palate, immune system problems, and developmental delays. Q93.81 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering chromosomal abnormalities, not elsewhere classified (q90-q99).
Q93.81 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code maps to RxHCC 148 (Mild Intellectual Disabilities) with a RAF weight of 0.0 in the RxHCC model. While it doesn't affect risk adjustment scoring, it identifies patients with 22q11 deletion syndrome who often require multiple medications including immunoglobulins, calcium supplements, psychiatric medications, and cardiac medications.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q93.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is one of the most common microdeletion syndromes; code associated cardiac defects, cleft palate, and immunodeficiency separately
- •Document the specific clinical features present as this syndrome has highly variable expression
Clinical Significance
Velocardiofacial syndrome (22q11 deletion syndrome/DiGeorge syndrome) is a genetic disorder characterized by heart defects, cleft palate, immune deficiency, and learning difficulties. This condition requires multidisciplinary care including cardiac monitoring, immune system support, speech therapy, and psychiatric management due to increased risk of mental health disorders.
Documentation Requirements
- ✓Genetic testing confirming 22q11 deletion
- ✓Cardiac abnormalities documented (conotruncal defects)
- ✓Palatal abnormalities or velopharyngeal insufficiency
- ✓Immune system dysfunction or recurrent infections
- ✓Characteristic facial features
- ✓Learning difficulties or intellectual disability
- ✓Psychiatric conditions if present
- ✓Calcium/parathyroid abnormalities
Commonly Confused Codes
- •Q9352 — Phelan-McDermid involves different chromosome region (22q13 vs 22q11)
- •Q9359 — Use specific velocardiofacial code when 22q11 deletion confirmed
- •Q9388 — Other microdeletions don't specifically involve 22q11
- •Q212 — Tetralogy of Fallot may be present but underlying genetic cause is key