Pediatric Coding Alert

Question: What ICD-10 code can I use for a newborn that a provider documents as born premature at 37 weeks? The preterm/premature newborn codes only go up to P07.39, which is for preterm newborns whose gestational age is 36 completed weeks.

Ohio Subscriber

Answer: The reason the P07.3- (Preterm [premature] newborn [other]) codes only go up to P07.39 (Preterm newborn, gestational age 36 completed weeks) is because “ICD-10-CM does not classify infants with a gestational age of 37 weeks or more as preterm,” according to AHA ICD-10-CM Coding Clinic (Vol. 4, No. 3: 2017).

This is in line with the American Academy of Pediatrics’ (AAP’s), definition of “late-preterm infants” as infants born between 34 weeks 0/7 days and 36 weeks 6/7 days as the AHA ICD-10-CM Coding Clinic goes on to point out (Source: publications.aap.org/pediatrics/article/120/6/1390/70578/Late-Preterm-Infants-A-Population-at-Risk).

In your particular case, AHA ICD-10-CM Coding Clinic advises you not to “assign a code for ‘late preterm infant,’ but to ‘query the physician whether the newborn is ‘small for dates’ or ‘light for dates.’” So, you should look to use appropriate codes from P05.0- (Newborn light for gestational age) and/or P05.1- (Newborn small for gestational age) in consultation with your pediatrician in cases where an infant is born between 37 and 40 weeks and is documented as being premature or, incorrectly, late preterm.