Pediatric Coding Alert

Question: We had a 2-week-old newborn contract bacterial pneumonia due to strep B, but they didn’t contract it during birthing. What code should I report if a neonate acquires a condition during the perinatal period but after leaving the hospital?

Pennsylvania Subscriber

Answer: Whenever a neonate gets sick during the delicate perinatal period but contracts the illness from someone in the community, the standard perinatal condition codes in chapter 16 won’t apply. See ICD-10 guideline I.C.16.a.5: “if the condition is community-acquired, a code from chapter 16 [P00-P96 (Certain Conditions Originating in the Perinatal Period)] should not be assigned.” If it’s clear that the newborn did not contract the pneumonia as a result of the birth process, and instead caught it from a family member for example, you’d turn to J15.3 (Pneumonia due to streptococcus, group B).

If the documentation is not clear though, heed the instructions that guideline I.C.16.a.5 goes on to explain: if the condition “may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used.” So, unless your pediatrician documents how the neonate acquired the condition, you should default to the P00-P96 codes.