P91.819: Neonatal encephalopathy, unspecified

Risk adjustment

P91.819 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 202 Coma, Brain Compression/Anoxic Damage0.543 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

P91.819 is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A57204Billing and Coding: MRI and CT Scans of the Head and Neck