R09.2
BillableRespiratory arrest
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R09.2 an HCC code?
Yes. R09.2 maps to Respiratory Arrest under the CMS-HCC V28 risk adjustment model (and Respiratory Arrest under V24).
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 R09.2
For R09.2 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 R09.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
R09.2 is the ICD-10-CM diagnosis code for respiratory arrest. A life-threatening condition where a person stops breathing completely, requiring immediate medical intervention. R09.2 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering symptoms and signs involving the circulatory and respiratory systems (r00-r09).
Under the CMS-HCC V28 risk adjustment model, R09.2 maps to Respiratory Arrest (HCC 212) with a community, non-dual, aged base RAF weight of 0.297. Under the older V24 model, R09.2 mapped to the same category but with a base RAF weight of 0.402 — V28 recalibrated weights across the entire model. 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 an emergent code - ensure documentation of the cause and any resuscitation efforts. Because R09.2 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 R09.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is an emergent code - ensure documentation of the cause and any resuscitation efforts
- •Distinguish between respiratory arrest and cardiac arrest
Clinical Significance
Respiratory arrest represents complete cessation of breathing and is a life-threatening emergency requiring immediate intervention. This condition has significant impact on risk adjustment as it indicates severe respiratory compromise and often requires intensive care management with high resource utilization and mortality risk.
Documentation Requirements
- ✓Documentation of complete cessation of spontaneous breathing
- ✓Circumstances leading to respiratory arrest
- ✓Interventions provided (mechanical ventilation, resuscitation)
- ✓Underlying cause if identified
- ✓Response to treatment
- ✓Duration of arrest if known
- ✓Associated cardiac arrest if present
- ✓ICU admission and monitoring