Revenue Cycle Insider

Question: The pediatrician evaluated a 7-day-old patient who was born prematurely. After assessing the patient’s breathing patterns during sleep, the pediatrician’s diagnosis was obstructive sleep apnea. How should this be coded?

North Carolina Subscriber

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

When a pediatrician has assessed a child’s respiratory patterns and determined that they have obstructive sleep apnea, it means that the child’s cessation of breathing during sleep is caused by a blockage in their airway. This blockage could be due to the child’s tongue or the muscles collapsing onto the airway during sleep.

Check the guidelines: If you are reading the pediatrician’s documentation and are unclear which obstructive sleep apnea code to assign between codes 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 be helpful to you. These guidelines tell us that any condition occurring “before birth through the 28th day following birth” falls under the perinatal period. Because the patient in the scenario is only 7 days old, P28.32 is the correct code choice.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC