Pulmonology Coding Alert

Pediatric Coding Updates:

Add Specificity to Newborn Sleep Apnea Coding With 2023 Changes

Published on Fri Jul 08, 2022

Learn the difference between CSA, OSA, and mixed sleep apnea.

Among the hundreds of code changes in the 2023 ICD-10-CM code set are the conversion and expansion of newborn apnea and sleep apnea codes. Effective Oct. 1, 2022, the 2023 ICD-10-CM code set features new codes that offer greater specificity when reporting an infant’s sleep diagnoses.

Appreciate an Apnea Refresher

Common in premature newborns, apnea is a condition where the regular breathing pattern is briefly interrupted. The condition can begin at any point during infancy, and infants can experience apnea while sleeping and awake.

To diagnose a baby with sleep apnea, the breathing pauses must occur while the newborn is sleeping and last for at least 20 seconds. The patient may present several symptoms of sleep apnea, including snoring, mouth breathing, difficulty swallowing, developmental delays, and labored breathing.

Three types of sleep apnea in newborns include:

Central sleep apnea (CSA)
Obstructive sleep apnea (OSA)
Mixed sleep apnea

CSA is caused by irregular signals from the brain that cause disruptions to a baby’s breathing patterns while sleeping. OSA occurs when the newborn’s throat narrows or closes during sleep, which blocks the airway and prevents the baby from inhaling. Mixed sleep apnea combines both CSA and OSA and appears as a failed attempt to inhale before or following an occurrence of CSA.

Review the 2022 ICD-10-CM Apnea Codes

The 2022 ICD-10-CM code set lists only P28.3 (Primary sleep apnea of newborn) and P28.4 (Other apnea of newborn) to cover sleep apnea and apnea diagnoses of newborns. Currently, P28.3 in the ICD-10-CM code set covers all forms of sleep apnea, including central and obstructive sleep apnea of a newborn as well as sleep apnea, not otherwise specified (NOS).

Meanwhile, P28.4 includes apnea of prematurity and obstructive apnea of a newborn. Code P28.4 also features an Excludes1 note listing newborn OSA (P28.3), which means you’re instructed to use P28.3 for newborn OSA, not P28.4.

P28.3 and P28.4 Become Parent Codes in the 2023 Code Set

Starting Oct. 1, 2022, ICD-10-CM converts P28.3 and P28.4 to parent codes, meaning these codes will become subcategories that require additional characters to be complete, reportable codes. “The new codes help to distinguish the separate causes of sleep apnea in newborns and infants,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

The descriptors for P28.3- and P28.4- haven’t changed in the 2023 ICD-10-CM code set, but the expanded subcategories include five new codes each. Plus, each of the new codes require a 5th character to ensure correct reporting.

Code Primary Newborn Sleep Apnea With Greater Specificity

Under P28.3-, you’ll find five expanded codes to report specific primary sleep apnea of newborn conditions. These new sleep apnea codes include:

P28.30 (Primary sleep apnea of newborn, unspecified)
P28.31 (Primary central sleep apnea of newborn)
P28.32 (Primary obstructive sleep apnea of newborn)
P28.33 (Primary mixed sleep apnea of newborn)
P28.39 (Other primary sleep apnea of newborn)

Newly added code P28.30 also lists “Transient oxygen desaturation spells of newborn during sleep” as a synonym, so you can correctly assign this code if the provider’s documentation includes that diagnosis.

While the 2022 P28.3 code covers all forms of sleep apnea, including central and obstructive sleep apnea of a newborn, those synonyms have been deleted from the 2023 ICD-10-CM code set to make way for P28.31 and P28.32, respectively. Additionally, P28.3- still features the synonym “Sleep apnea of newborn NOS” in ICD-10-CM 2023.

Correctly Code Other Newborn Apnea Conditions

Parent code P28.4- also brings several revisions into the 2023 code set. The five expanded codes under P28.4- cover other forms of apnea in a newborn, including:

P28.40 (Unspecified apnea of newborn)
P28.41 (Central neonatal apnea of newborn)
P28.42 (Obstructive apnea of newborn)
P28.43 (Mixed neonatal apnea of newborn)
P28.49 (Other apnea of newborn)

Expanded code P28.40 also includes the synonyms “Transient oxygen desaturation spells of newborn” and “Apnea of newborn, NOS.” The “Apnea of prematurity” synonym has been moved from P28.4- to P28.49. Obstructive apnea of newborn has also been deleted from P28.4- since code P28.42 covers the diagnosis.

What is apnea of prematurity? This condition occurs when infants, particularly those born prematurely, experience short stops in breathing due to the immaturity of the brain or weakness in the muscles that help keep the infant’s airways open. The apnea may be worsened by other stresses in the baby, including low oxygen levels, low blood count, feeding issues, overstimulation, and infections.

Excludes2 notes: The 2023 ICD-10-CM code set adds Excludes2 notes to P28.3- and P28.4- parent codes that reference each other. This means you could assign a P28.3- code in conjunction with a P28.4- code if the two conditions are occurring simultaneously.

Could More Specific Diagnosis Codes Mean Better Treatment?

Each of the causes covered by the new codes may be treated in a specific manner, but home monitoring is a common tool used in care of the infant. “Having a more specific diagnosis linked to the patient’s medical record may positively impact the care that they receive, more specifically when parents are seeking acute care for their infant if their home monitoring device suggests a problem. The treatment can be implemented in a timelier manner, if the clinicians know what type of apnea is involved,” Pohlig says.