ICD 10 Coding Alert

Question: The pediatrician evaluated a 5-day-old patient who was born prematurely. After careful assessment of the patient’s breathing patterns during sleep, the pediatrician diagnoses the baby with obstructive sleep apnea. Is there a specific code for this condition?

Oregon Subscriber

Answer: Yes. You’ll report P28.32 (Primary obstructive sleep apnea of newborn) in this scenario.

If the pediatrician evaluated the patient’s breathing patterns and diagnosed the child with obstructive sleep apnea, that means when the baby stopped breathing during sleep it was due to an obstruction in the airway. Obstructions can be the patient’s tongue or the muscles collapsing on the airway. It wasn’t until Oct. 1, 2022, that there were specific codes to distinguish between the different causes of newborn and infant sleep apnea, so it’s understandable why you were unfamiliar with it.

Guideline alert: If you are reading the provider’s documentation and are unsure which obstructive sleep apnea to assign between P28.32 and G47.33 (Obstructive sleep apnea (adult) (pediatric)), a review of the ICD-10-CM Official Guidelines, Section I.C.16 — which applies to P codes — will help. The guidelines instruct that any condition occurring “before birth through the 28th day following birth” falls under the perinatal period. Since the patient in the scenario is only 5 days old, P28.32 is the correct code.