ICD-10 Coding for Prematurity(P07.20, P07.30)
Complete ICD-10-CM coding and documentation guide for Prematurity. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Prematurity
P07.2-P07.3Primary Range
Disorders of newborn related to short gestation and low birth weight, not elsewhere classified
This range includes codes for prematurity based on gestational age.
Disorders of newborn related to slow fetal growth and fetal malnutrition
These codes are used for infants small or light for gestational age.
Low birth weight and immaturity status
These codes are used to indicate low birth weight in conjunction with prematurity.
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 | Extreme immaturity of newborn, unspecified weeks of gestation | Use when gestational age is less than 28 weeks and specific weeks are not documented. |
|
| P07.30 | Preterm newborn, unspecified weeks of gestation | Use when gestational age is between 28 and 36 weeks and specific weeks are not documented. |
|
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 prematurity
Essential facts and insights about Prematurity
Primary ICD-10-CM Codes for prematurity
Decision Criteria
documentation Criteria
- Gestational age must be explicitly documented.
Applicable To
- Newborn less than 28 completed weeks of gestation
Excludes
- Post-term infant (P08.21)
Clinical Validation Requirements
- Gestational age confirmed by early ultrasound
- Documentation of birth at less than 28 weeks
Code-Specific Risks
- Risk of incorrect coding if gestational age is not documented
Coding Notes
- Ensure gestational age is documented to avoid queries.
P07.30 - Preterm newborn, unspecified weeks of gestation
Use when gestational age is between 28 and 36 weeks and specific weeks are not documented.
Applicable To
- Newborn 28-36 completed weeks of gestation
Excludes
- Post-term infant (P08.21)
Clinical Validation Requirements
- Gestational age confirmed by early ultrasound
- Documentation of birth between 28 and 36 weeks
Coding Notes
Ensure gestational age is documented to avoid queries.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Prematurity to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code P07.20.
Impact
Clinical: Misclassification of gestational age., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential reimbursement issues.
Mitigation Strategy
Verify gestational age before coding., Educate providers on documentation requirements.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure gestational age is documented in weeks and days.
Impact
Lack of specific gestational age documentation can lead to audit issues.
Mitigation Strategy
Implement mandatory documentation checks 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 Prematurity, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Prematurity
Use these documentation templates to ensure complete and accurate documentation for Prematurity. These templates include all required elements for proper coding and billing.
NICU Discharge Summary
Specialty: NeonatologyRequired Elements
- Gestational age
- Birth weight
- Complications
- Final diagnoses
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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