ICD-10 Coding for Premature Birth(P07.20, P07.30)
Complete ICD-10-CM coding and documentation guide for Premature Birth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Premature Birth
P07.2-P07.3Primary Range
Disorders of newborn related to short gestation and low birth weight, not elsewhere classified
Primary range for coding premature birth based on gestational age and birth weight.
Liveborn infants according to place of birth and type of delivery
Used as the principal diagnosis for newborns, indicating the birth event.
Preterm labor leading to preterm delivery
Used on the maternal record to indicate preterm labor resulting in delivery.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| P07.20 | Extremely low birth weight newborn, unspecified weight | Use when the newborn's birth weight is less than 1000 grams and gestational age is documented. |
|
| P07.30 | Preterm newborn, unspecified weeks of gestation | Use when the newborn's gestational age is less than 37 weeks. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for premature birth
Essential facts and insights about Premature Birth
Primary ICD-10-CM Codes for premature birth
Decision Criteria
clinical Criteria
- Birth weight less than 1000 grams
documentation Criteria
- Gestational age confirmed by early ultrasound
Applicable To
- Newborn with birth weight less than 1000 grams
Excludes
- Newborn with birth weight 1000 grams or more
Clinical Validation Requirements
- Birth weight documentation
- Gestational age confirmation
Code-Specific Risks
- Incorrect weight documentation
- Misclassification of gestational age
Coding Notes
- Ensure accurate birth weight and gestational age documentation.
P07.30 - Preterm newborn, unspecified weeks of gestation
Use when the newborn's gestational age is less than 37 weeks.
Applicable To
- Newborn with gestational age less than 37 weeks
Excludes
- Newborn with gestational age 37 weeks or more
Clinical Validation Requirements
- Gestational age documentation
- Confirmation by early ultrasound or LMP
Coding Notes
Ensure accurate gestational age documentation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Single liveborn infant, born in hospital
Z38.00Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Premature Birth to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code P07.20.
Impact
Clinical: Impacts clinical decision-making and care planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use specific terms like '32 weeks gestation', Include birth weight and delivery details
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure 'O' codes are only used on maternal records.
Impact
Reimbursement: Potential for incorrect DRG assignment., Compliance: Violation of ICD-10 coding rules., Data Quality: Misleading clinical data.
Mitigation Strategy
Verify gestational age documentation and query if necessary.
Impact
Inaccurate documentation of gestational age can lead to coding errors.
Mitigation Strategy
Implement standardized documentation protocols for gestational age.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Premature Birth, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Premature Birth
Use these documentation templates to ensure complete and accurate documentation for Premature Birth. These templates include all required elements for proper coding and billing.
Neonatal Intensive Care Unit Admission
Specialty: NeonatologyRequired Elements
- Gestational Age
- Birth Weight
- Delivery Method
- Complications
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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