Pediatric Coding Alert

Here’s what you need to know about when and how to apply the perinatal period codes.

About the only thing coders can generally agree on about the P00-P96 (Certain Conditions Originating in the Perinatal Period) codes is that they are never to be used on the mother’s medical record. But exactly when and how should they be applied to the newborn’s record?

To clear up that little mystery, we’ve answered your most frequently asked questions regarding neonatal condition coding. Here’s a big hint: sometimes the code you need isn’t in Chapter 16 at all.

Do I Only Use a Code From Chapter 16 While the Patient Is 28 Days or Younger?

While ICD-10 is clear that “the perinatal period is defined as before birth through the 28th day following birth,” per the introduction to the Chapter 16 guidelines, you can’t automatically reach for a P00-P96 code from the time a neonate is born through to the end of their 28th day of life for two reasons.

First, guideline I.C.16.a.3 warns you that you should use other codes with codes from Chapter 16 if they “provide more specific details,” or to use sign and symptom codes “when a definitive diagnosis has not been established,” regardless of whether the patient is a neonate or not.

Second, both guideline I.C.16.a.1 and guideline I.C.16.a.4 tell you that, “should a condition originate in the perinatal period, and continue throughout the life of the patient, the perinatal code should continue to be used regardless of the patient’s age.” So, per the example accompanying guideline I.C.16.e., “codes from category P07, Disorders of newborn related to short gestation and low birth weight, not elsewhere classified, are for use for a child or adult who was premature or had a low birth weight as a newborn and this is affecting the patient’s current health status.”

Watch out for these denials. Payers have been known to ignore these guidelines. “Some of our clinics get rejections from clearinghouses or from health plans for claims with codes from chapter 16 for patients older than 28 days of age,” cautions JoAnne M. Wolf, RHIT, CPC, CEMC, AAPC Fellow, coding manager at Children’s Health Network in Minneapolis. “When this happens, clinics should cite these chapter-specific guidelines,” Wolf suggests.

When Do I Apply Codes Outside of P00-P96 for Perinatal Conditions?

Simply put, you’ll look up a given condition in the ICD-10 alphabetic index as you would any condition. If there is no P code listed in the entry, then you’ll go ahead and use a code out of the appropriate group. For example, “infantile colic often occurs during the perinatal period, but it does not have an ICD-10 neonatal P code assigned to it,” says Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics, LLP, in Northampton, Massachusetts. In a situation like this, you’ll use R10.83 (Colic).

Should I Add Another Code When This Happens?

When there is no specific code listed for the condition in the ICD-10 alphabetic index when it occurs in the perinatal period, “as a general rule, you’ll assign code P96.89 (Other specified conditions originating in the perinatal period) followed by the code from another chapter that specifies the condition,” Walaszek suggests.

What If the Neonate Acquired the Condition Outside of the Hospital/Birth Process?

In situations where the neonate acquires a condition during the perinatal period but after leaving the hospital and entering into the community setting, coding is subject to guideline I.C.16.a.5, which tells you that “if the condition is community-acquired, a code from Chapter 16 should not be assigned.”

For example, suppose a 2-week-old newborn is exposed to a sick family member and contracts bacterial pneumonia due to strep B. “As this condition was not caused by the birth process, it would not be appropriate to report a code from chapter 16. Instead, you should report J15.3 [Pneumonia due to streptococcus, group B],” according to Wolf.

Remember this exception: Guideline I.C.16.a.5 also tells you that if the condition “may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used.” So, unless your pediatrician stipulates how the neonate acquired the condition, you should default to the P00-P96 codes.