Pediatric Coding Alert

Question: Our pediatrician just saw an infant who was born premature at 29 weeks and who was released from the neonatal intensive care unit (NICU) at two months. As the infant’s birth weight was low, the pediatrician just wanted the infant to come in for a weight check; otherwise, the baby was fine, and there is nothing in the note to show there were any other problems. The pediatrician recorded P07.15 and P07.32. Can I use these codes since the baby is now past the perinatal period and there are no other issues that I can put on the claim?

AAPC Forum Participant

Answer: Even though the introductory guideline to the Chapter 16 codes states, “for coding and reporting purposes the perinatal period is defined as before birth through the 28th day following birth,” and the patient is, as you state, past that age, another guideline overrides that first guideline.

Guideline I.C.16.a.4. states 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, in this encounter, your pediatrician was correct in assigning P07.15 (Other low birth weight newborn, 1250-1499 grams) and P07.32 (Preterm newborn, gestational age 29 completed weeks).

Sequencing alert: For the P00-P96 codes, guideline I.C.16.d. instructs you to assign “two codes from category P07 … when both birth weight and gestational age are available … with the code for birth weight sequenced before the code for gestational age.”