Z93.0 ICD-10-CM Code: Tracheostomy status
Z93.0 maps to CMS-HCC V28 211. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z93.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceTracheostomy 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.
Buddy Insight
This code represents a major alteration in respiratory anatomy that significantly impacts patient care complexity and resource utilization.
CMS-HCC V28
MappedHCC 211
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 125
Code-level coefficient reference
ESRD/PACE
MappedHCC 82
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for Z93.0. Check the code and parent instructions in the Code Book.
Excludes 2
OfficialNo Excludes 2 notes are included in this display for Z93.0. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for Z93.0. Check the code and parent instructions in the Code Book.
Excludes 1
Official- artificial openings requiring attention or management (Z43.-)Inherited from Z93
- complications of external stoma (J95.0-, K94.-, N99.5-)Inherited from Z93
Code First
OfficialNo Code First sequencing instructions are included in this display for Z93.0. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for Z93.0. Check the code and parent instructions in the Code Book.
Code Also
Official- any follow-up examination (Z08-Z09)Inherited from Z77-Z99
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 Z93.0 an HCC code?
Yes. Z93.0 (Tracheostomy status) maps to HCC 211, Respirator Dependence/Tracheostomy Status/Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.879. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: Z93.0 is billable and maps to V28 HCC 211, Respirator Dependence/Tracheostomy Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- Z93.0
- Description
- Tracheostomy status
- HCC (V28)
- HCC 211 — Respirator Dependence/Tracheostomy Status/Complications
- RAF reference coefficient
- 0.879
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work Z93.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for Z93.0
For Z93.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 source-labeled community, non-dual, aged reference coefficient of 0.879. No V24 mapping is shown for Z93.0; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
This code indicates the patient currently has a tracheostomy; use it for all encounters where the tracheostomy is present. For Z93.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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