ICD-10 CM Guidelines for Chapter 16: Conditions Originating in the Perinatal Period

Introduction

• Presenter: Tiffany Roach, the Coding Coach
• Focus: Review ICD-10 CM guidelines for Chapter 16, covering codes P00.00 through P96
• Applicability: Guidelines effective for fiscal years 2024 and 2025 (no changes between these years)
• Definition of Perinatal: Birth through the 28th day following birth

Key Guidelines

Usage of Chapter 16 Codes

• Not for Maternal Record: Chapter 16 codes are never to be used for the maternal record.
• Life Usage: May be used throughout patient's life if the condition is present.
• Resolution of Condition: If resolved, do not use Chapter 16 codes.

Coding for Birth Episodes

• Principal Diagnosis: Use a code from category Z38 to indicate place of birth and type of delivery.
• Transfer Cases: Z38 should not be reassigned at receiving hospitals.

Combining Chapter 16 with Other Codes

• Additional Detail: Chapter 16 codes can be combined with codes from other chapters to provide more precise details.
• Signs and Symptoms: Codes can be assigned if a definitive diagnosis is not established.

Sequencing and Continuation of Conditions

• Sequencing: If the encounter is due to a perinatal condition, Chapter 16 code should be first.
• Continuing Conditions: Use Chapter 16 codes if conditions persist beyond perinatal period.

Birth Process vs. Community Acquired

• Default to Birth Process: Use Chapter 16 codes unless condition is confirmed as community acquired.

Evaluation and Reporting

Clinically Significant Conditions

• Coding Requirement: Requires clinical evaluation, treatment, diagnostic procedures, or implications for future care.

Observation Codes

• No Condition Present: Use Z05 for evaluation of suspected but non-present conditions.
• Healthy Newborns: Z05 can be principal diagnosis for readmissions if no conditions are present.

Prematurity and Low Birth Weight

• Prematurity: Assign codes only if documented by provider.
• Code Assignment: Use both birth weight and gestational age from categories P05 and P07.

Bacterial Sepsis

• Congenital Sepsis: Default to congenital unless specified otherwise; use P36.
• Causal Organism: If not included, additional code from B95/B96 is required.

Other Specific Guidelines

• Stillbirths: Code P95 used only if separate records are maintained, and not alongside any other code.
• COVID-19 in Newborns: Assign U07.1 for positive tests, P35.8 if contracted in utero.

Conclusion

• Reminder: Important to adhere to guidelines for accurate coding.
• Continued Learning: Subscribe to stay updated on future guideline reviews.