Z93.0
BillableTracheostomy status
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Z93.0 an HCC code?
Yes. Z93.0 maps to Respirator Dependence/Tracheostomy Status/Complications under the CMS-HCC V28 risk adjustment model (and Respirator Dependence/Tracheostomy Status 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 Z93.0
For Z93.0 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 Z93.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
Z93.0 is the ICD-10-CM diagnosis code for tracheostomy status. A patient has a tracheostomy, which is a surgically created opening in the windpipe that allows breathing and may be used for long-term ventilation support. Z93.0 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Under the CMS-HCC V28 risk adjustment model, Z93.0 maps to Respirator Dependence/Tracheostomy Status/Complications (HCC 211) with a community, non-dual, aged base RAF weight of 0.450. Under the older CMS-HCC V24 model, Z93.0 maps to Respirator Dependence/Tracheostomy Status (HCC 82) with a community, non-dual, aged base RAF weight of 1.241. 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 code indicates the patient currently has a tracheostomy; use it for all encounters where the tracheostomy is present. Because Z93.0 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 Z93.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code indicates the patient currently has a tracheostomy; use it for all encounters where the tracheostomy is present
- •Document whether the tracheostomy is temporary or permanent, and if the patient is ventilator-dependent
Clinical Significance
This code represents a major alteration in respiratory anatomy that significantly impacts patient care complexity and resource utilization. Tracheostomy status requires specialized nursing care, increased infection monitoring, and ongoing airway management, often indicating severe underlying respiratory or neurological conditions.
Documentation Requirements
- ✓Confirmation of active tracheostomy presence
- ✓Type of tracheostomy (temporary vs permanent)
- ✓Indication for tracheostomy creation
- ✓Current functionality and patency
- ✓Care requirements and frequency
- ✓Any complications or concerns
- ✓Ventilator dependence if applicable
- ✓Planned duration or permanence