Pediatric Coding Alert

Question: One of our pediatricians saw a 10-year-old for a routine check-up. During the exam, the doctor noted that the child was significantly smaller and lighter than average. The mother mentioned her child was born prematurely and had a low birth weight, The pediatrician confirmed this and documented it to be related to the growth delay. Do I need to code the premature birth?

Virginia Subscriber

Answer: Yes, even though premature birth is a perinatal condition (which is the period from birth through the 28^th day), you should report the P07 (Disorders of newborn related to short gestation and low birth weight, not elsewhere classified) codes if they are relevant to the patient’s current condition.

Take a look at the ICD-10 guidelines I.C.16.a.1 and I.C.16.a.4, which both 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… 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.”

However, watch out for denials. Some payers might overlook these guidelines and deny claims that report chapter 16 codes for patients older than 28 days. If this happens, appeal and cite the chapter-specific guidelines.