Basic ICD-10-CM/PCS Coding 2013 Edition

1. Basic ICD-10-CM/PCS Coding2013 Edition Chapter 19: Certain Conditions Originating in the Perinatal Period (P00–P96)

2. Learning Objectives • Review the chapter’s learning objectives and key terms • At the conclusion of this chapter, what must you know about the coding of certain conditions originating in the perinatal period?

3. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) Codes in Chapter 16 are arranged in the following block: P00–P04 Newborn affected by maternal factors and by complications of pregnancy, labor and delivery P05–P08 Disorders of newborn related to length of gestation and fetal growth P09 Abnormal findings on neonatal screening P10–P15 Birth trauma

4. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) Codes in Chapter 16 are arranged in the following block (continued): P19–P29 Respiratory and cardiovascular disorders specific to the perinatal period P35–P39 Infections specific to the perinatal period P50–P61 Hemorrhagic and hematological disorders of the newborn P70–P74 Transitory endocrine and metabolic disorders specific to newborn

5. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) Codes in Chapter 16 are arranged in the following block (continued): P76–P78 Digestive system disorders of newborn P80–P83 Conditions involving the integument and temperature regulation of newborn P84 Other problems with newborn P90–P96 Other disorders originating in the perinatal period

6. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) Conditions coded in chapter 16 of ICD-10-CM describe conditions that begin before birth or develop during the first 28 days of life or the perinatal period These conditions may continue to exist past the first 28 days of life and can be coded regardless of the patient’s age

7. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) In ICD-10-CM category P00–P04, newborns affected by maternal factors and by complications of pregnancy, labor and delivery, the phrase “suspected to be” is included in the code title as a nonessential modifier to indicate that the codes are for use when the listed maternal condition is specified as the cause of the confirmed or suspected newborn morbidity or potential morbidity

8. Chapter 16 of ICD-10-CM, Certain Conditions Originating in the Perinatal Period (P00–P96) Codes for perinatal conditions are organized by type, for example, disorders related to length of gestation and fetal growth versus conditions produced by birth trauma. Other blocks of codes are grouped by the type of condition or the body system where the disease is present

9. Coding Instructional Notes for ICD-10-CM, Chapter 16 Codes from Chapter 16 are only for use on the newborn or infant record, never on the maternal record Conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later If the condition originated in the perinatal period and continues throughout the life of the patient, the perinatal code should continue to be used regardless of the age of the patient

10. Coding Instructional Notes for ICD-10-CM, Chapter 16 Notes in the chapter clarify how codes are to be sequenced. For example: Note under P07: When both birth weight and gestational age of the newborn are available, both should be coded with the birth weight sequenced before gestational age Notes define codes. For example: Note under P08.21 define post-term newborn: gestation period over 40 completed weeks to 42 completed weeks

11. Coding Guidelines for ICD-10-CM, Chapter 16 NCHS has published chapter-specific guidelines for Chapter 15 that address: General perinatal rules Observation and evaluation of newborns for suspected conditions not found Coding additional perinatal diagnoses Prematurity and fetal growth retardation Low birth weight and immaturity status Bacterial sepsis of newborn Stillbirth

12. Coding Conditions in ICD-10-CM Chapter 16 Codes in this chapter describe conditions are used on the newborn records, never on the maternal records Codes identify newborns affected by maternal forces, disorders related to length of gestation and fetal growth, abnormal findings on neonatal screening, birth trauma, infections and conditions in various body systems that originate in the perinatal period

13. Coding Conditions in ICD-10-CM Chapter 16 Newborn Affected by Maternal Forces and by Complications of Pregnancy, Labor and Delivery (P00–P04) Maternal condition that is the cause or is suspected to be the cause of the newborn’s condition Titles of categories include word “suspected” as a nonessential modifier

14. Coding Conditions in ICD-10-CM Chapter 16 Newborn Affected by Maternal Forces and by Complications of Pregnancy, Labor and Delivery (P00–P04) Category P04 identifies through the use of fourth or fifth character the substance (suspected) found to have harmed the fetus or newborn Substances include maternal anesthesia, analgesia other medications, tobacco used as well as the use of alcohol and drugs of addiction Main term in Index: Newborn, affected by (suspected to be) with subterms for the maternal condition affecting newborn

15. Coding Conditions in ICD-10-CM Chapter 16 Disorders of Newborn Related to Length of Gestation and Fetal Growth (P05–P08) include P05 Disorders of newborn related to slow fetal growth and fetal malnutrition P07 Disorders of newborn related to short gestation and low birth weight, not elsewhere classified P08 Disorders of newborn related to long gestation and high birth weight

16. Coding Conditions in ICD-10-CM Chapter 16 Disorders of Newborn Related to Slow Fetal Growth and Fetal Malnutrition (P05) Infant diagnosed as light-for-dates or light for gestational age May also be “small-for-dates” babies Another term used is “fetal growth retardation” (FGR) P05.0, Newborn light for gestational age P05.1, Newborn small for gestational age Fifth characters are used for both codes to identify the weight of the infant at birth

17. Coding Conditions of ICD-10-CM Chapter 16 Disorders of Newborn Related to Short Gestation and Low Birth Weight, Not Elsewhere Classified (P07) Two subcategories identify low birth weight P07.0 Extremely low birth weight newborn Codes describe birth weight of 999 grams or less P07.1 Other low birth weight newborn Codes describe birth weight of 1000-2499 grams

18. Coding Conditions of ICD-10-CM Chapter 16 Disorders of Newborn Related to Short Gestation and Low Birth Weight, Not Elsewhere Classified (P07) Two subcategories identify short gestational age P07.2 Extreme immaturity of newborn Less than 28 completed weeks or less than 196 completed days of gestation P07.3 Preterm (premature) newborn 28 completed weeks or more but less than 37 completed weeks or 196 completed days but less than 259 completed days of gestation

19. Coding Conditions of ICD-10-CM Chapter 16 Disorders of Newborn Related to Long Gestation and High Birth Weight (P08) May be described as a large baby or extremely large baby Other phrases are heavy-for-dates or large-for-dates Assignment of the code for birth weight should take priority over the estimate gestational age code Physicians must document the condition in order for it to be coded

20. Coding Conditions of ICD-10-CM Chapter 16 Disorders of Newborn Related to Long Gestation and High Birth Weight (P08) P08.0, Exceptionally large newborn is used for a baby with birth weight of 4500 grams or more P08.8 is used for birth weight between 4000 and 4499 grams P08.2 is used for “late newborn,” not heavy for gestational age with fifth characters for the number of completed weeks of gestational age Main terms used in the Index include premature newborn, preterm newborn, immaturity, small-for-dates, light-for-date, low birth weight, heavy-for-dates and large baby

21. Coding Conditions of ICD-10-CM Chapter 16 Conditions Associated with Meconium Meconium is a thick substance that lines the infant’s intestine during gestation and consists of a combination of swallowed amniotic fluid and mucus form the baby. Baby can pass meconium out of their bowel prior to birth which is excreted into the amniotic fluid. Passage in utero will show the amniotic fluid as having meconium staining and baby will be watch closely for fetal distress Meconium aspiration syndrome occurs when meconium is aspirated by the infant into their lungs with their first breath

22. Coding Conditions of ICD-10-CM Chapter 16 Conditions Associated with Meconium Distinct codes for different conditions involving meconium P03.82 Meconium passage during delivery P24.00 Meconium aspiration without respiratory symptoms P24.01 Meconium aspiration with respiratory symptoms (aspiration syndrome) P76.0 Meconium ileus (plug syndrome) P78.0 Meconium peritonitis P96.83 Meconium staining (of amniotic fluid)

23. Coding Conditions of ICD-10-CM Chapter 16 Respiratory and Cardiovascular Disorders Specific to the Perinatal Period (P19–P29) Example is respiratory distress syndrome (RDS) of newborn P22.0 Respiratory distress syndrome of newborn. This is RDS or RDS type I P22.1 Transient tachypnea of newborn which is used for RDS type II, idiopathic tachypnea of newborn or wet lung syndrome Other conditions are coded with Category P24, neonatal aspiration with fifth-characters of 0 for without respiratory symptoms and 1 for with respiratory symptoms

24. Coding Conditions of ICD-10-CM Chapter 16 Respiratory and Cardiovascular Disorders Specific to the Perinatal Period (P19–P29) Category P29, Cardiovascular disorders, contain neonatal cardiac conditions. Infants with bradycardia or tachycardia after birth may have an underlying condition but not immediately known and coded as P29.11 Neonatal tachycardia P29.12 Neonatal bradycardia Persistent fetal circulation, P29.3, is used for conditions described as delayed closure of ductus arteriosus or persistent pulmonary hypertension of newborn

25. Coding Conditions of ICD-10-CM Chapter 16 Infections Specific to the Perinatal Period (P35-P39) Infections may be acquired in utero, during birth via the umbilicus or during the first 28 days of life Infant with urinary tract infection at age of 20 days is coded with P39.3, neonatal urinary tract infection Guideline states if a newborn has a condition that may be either community acquired or due to the birth process and the documentation does not indicate which it is, the default code should be assigned to the code associated with the birth process (Chapter 16 code). Community acquired conditions are assigned with codes from other chapters

26. Coding Conditions of ICD-10-CM Chapter 16 Infections Specific to the Perinatal Period (P35–P39) Category P36, bacterial sepsis of newborn, contains codes frequently to classify conditions in newborns with infections Unique codes exist for septicemia or sepsis of newborn due to various organisms. If the P36 does not include the causal organism, the coder should assign an additional code from category B96 to identify organism If the infant has severe sepsis, the coder should assign an additional code to identify severe sepsis and any associated acute organ dysfunction

27. Coding Conditions of ICD-10-CM Chapter 16 Liveborn Infants According to Place of Birth and Type of Delivery (Z38) Birth episode is coded with a code from category Z38, Liveborn infants according to place of birth and type of delivery Z38 codes identify the number of liveborn infants, where the infant was born (in or outside hospital) and how they were delivered (vaginally or by cesarean) Z38 code is assigned only once to a newborn at the time of birth Main term in Index is “newborn” with subterms to be reviewed

28. Coding Procedures for Certain Condition Originating in the Perinatal Period in ICD-10-PCS No unique procedures to treat certain conditions originating in the perinatal period Instead procedures performed on infants are coded according to the root operation and the body system involved Supportive services for infants are in the extra-corporeal assistance and performance section for mechanical ventilation, CPAP, or IABP

29. Exercises Practice coding the conditions included in Chapter 16 of ICD-10-CM for certain conditions originating in the perinatal period as well as the procedures used to treat these conditions by completing the review exercises for Chapter 19.