ICD-10-CM codes begin with a letter and are followed by up to five numbers or alpha characters. All letters of the alphabet are used (except U), and valid codes can contain three, four, five, or six characters, with some chapters requiring a 7th character extension. The ICD is used to translate diagnoses of diseases and other health problems from words into an alphanumeric code, which permits easy storage, retrieval and analysis of the data.
The ICD classification is designed to promote international comparability in the collection, processing, and presentation of mortality and morbidity statistics, as well as reimbursement based on medical necessity. It is used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and patient records. The reported conditions are then translated into medical codes in accordance with the classification structure and the selection and modification rules contained in the applicable revision of the ICD-10 Official Guidelines.
Codes that can last a lifetime!
ICD-10-CM organizes diagnosis codes for newborns in Chapter 16 “blocks”:
- P00-P04 Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery;
- P05-P08 Disorders related to length of gestation and fetal growth;
- P09 Abnormal findings on neonatal screening;
- P10-P15 Birth trauma;
- 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 newborn;
- P70-P74 Transitory endocrine and metabolic disorders specific to newborn;
- P76-P78 Digestive system disorders of newborn;
- P80-P83 Conditions involving the integument and temperature regulation of newborn;
- P84 Other problems with newborn; and,
- P90-P96 Other disorders originating in the perinatal period.
The perinatal period describes conditions that have their origin in the time immediately before birth (depending on definitions, this could be between the 20th to 28th week of gestation), through the first 28 days after birth. Codes in this chapter are never used on the mother’s record. Perinatal conditions may exist throughout the life of the patient, and chapter 16 codes may be assigned if the condition is still present.
The birth episode of care for the newborn is assigned a code from category Z38, Liveborn according to place of birth and type of delivery. Z38 is the first listed code, and assigned only once, to a newborn at the time of birth. Category Z38 is only used on the newborn chart, never the mother’s record. Example, Z38.30 describes twin liveborn infant, delivered vaginally. All clinically significant conditions noted on a routine newborn examination should be coded. If the reason for the encounter is a perinatal condition, the code from chapter 16 should be sequenced first.
There are many instances where a newborn is observed for a suspected condition, but after study that condition is ruled out. ICD-10 chapter 16, code block P00-P04, has codes for use for newborns suspected of having an abnormality resulting from exposure from the mother or the birth process but without signs or symptoms, and, after examination and observation, is found not to exist. Example, code P04.41 Newborn (suspected to be) affected by maternal use of cocaine, or code P00.0 Newborn (suspected to be) affected by maternal hypertensive disorders.
Prematurity and Fetal Growth Retardation
Prematurity and Fetal Growth Retardation (P05-P08) describe newborn gestational age and weight disorders. Providers utilize different criteria in determining prematurity. A code for prematurity should not be assigned unless it is documented. Assignment of codes in categories P05, Disorders of newborn related to slow fetal growth and fetal malnutrition, and P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, should be based on the recorded birth weight and estimated gestational age. Codes from category P05 should not be assigned with codes from category P07. When both birth weight and gestational age are available, two codes from category P07 should be assigned, with the code for birth weight sequenced before the code for gestational age. Example, P05.12 (Newborn small for gestational age, 500-749 grams), and code P07.22 (Extreme immaturity of newborn, 24-26 completed weeks).
Other conditions described in chapter 16 include:
- birth injuries,
- aspiration conditions,
- respiratory conditions,
- infections and
- endocrine disorders.
Feeding problems are described in category P92, and include vomiting, slow feeding, underfeeding, fast feeding, and difficulty in feeding at breast.
The majority of diagnosis codes listed in chapter 16 have 4 or 5 digits; there are no 7th character requirements in this chapter. Documentation must support all code assignments and sequencing of first-listed and secondary conditions must be accurate.
Diagnosis codes are to be used and reported at their highest number of digits available. ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 digits. Codes with three digits are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth digits, which provide greater detail. A three-digit code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable. The coder must pay attention to chapter instructions and follow the official guidelines as well. The draft manual of ICD-10 contains official guidelines and chapter highlights.
Nancy Maguire, ACS, PCS, FCS, HCS-D, CRT, author of The Nancy Maguire GPS to ICD-10-CM Planning and Implementation Guide, is a nationally-renowned procedural and diagnostic coding instructor, bootcamp trainer, and workshop leader. She has spent more than 30 years as a hands-on coder and has authored countless coding articles and presentations. In her expansive career, she has transitioned from nursing, to coding, to practice management, auditing and consulting. Nancy served as Director of Coding and Reimbursement at UTMB in Galveston Texas for four years. She served the first two terms as president of AAPC in the early 1990s.
Hear Nancy speak in two complimentary archived webinars on ICD-10 presented by Kareo medical billing software: How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction) or Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding. You can also read her entire series of articles on ICD-10.