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v1.0.0
ICD-10 Guide
ICD-10 CodesP07.21

P07.21

Billable

Extreme immaturity of newborn, gestational age less than 23 completed weeks

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P07.21 is a billable code used to indicate a diagnosis of extreme immaturity of newborn, gestational age less than 23 completed weeks.

Key Diagnostic Point:

Extreme immaturity of newborn, classified under ICD-10 code P07.21, refers to infants born at a gestational age of less than 23 completed weeks. These newborns are at a significantly increased risk for a variety of complications due to their underdeveloped organ systems. Common issues include respiratory distress syndrome due to immature lungs, intraventricular hemorrhage, and necrotizing enterocolitis. The survival rate for these infants is low, and those who do survive often face long-term health challenges. Maternal factors such as preterm labor, infections, and placental insufficiency can contribute to extreme immaturity. Delivery complications, including emergency cesarean sections or prolonged labor, may also play a role in the birth of these extremely premature infants. Care for these newborns typically occurs in a Neonatal Intensive Care Unit (NICU), where they require specialized monitoring and interventions to support their fragile health status.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation and outcomes among extremely premature infants.
  • Need for detailed documentation of maternal health factors and delivery complications.
  • Potential for multiple co-morbid conditions requiring additional coding.
  • Frequent updates to clinical guidelines and coding standards.

Audit Risk Factors

  • Inadequate documentation of gestational age.
  • Failure to capture all relevant maternal and delivery complications.
  • Misclassification of the infant's condition based on gestational age.
  • Inconsistent coding practices across different healthcare providers.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of gestational age, birth weight, and immediate postnatal care.

Common Clinical Scenarios

Management of respiratory support, monitoring for signs of infection, and nutritional support in the NICU.

Billing Considerations

Accurate coding requires understanding of the infant's clinical course and any interventions performed.

Pediatrics

Documentation Requirements

Comprehensive history of perinatal events and ongoing developmental assessments.

Common Clinical Scenarios

Follow-up care for developmental delays and chronic health issues stemming from extreme prematurity.

Billing Considerations

Pediatric coders must be aware of the long-term implications of extreme immaturity on health outcomes.

Coding Guidelines

Inclusion Criteria

Use P07.21 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of gestational age and any associated maternal conditions
  • Use additional codes to capture complications and co
  • morbidities as necessary

Exclusion Criteria

Do NOT use P07.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, per day, for evaluation and management of a normal newborn infant.

Clinical Scenario

Used for initial assessment of an extremely premature infant in the NICU.

Documentation Requirements

Document the infant's gestational age, weight, and any immediate interventions.

Specialty Considerations

Neonatologists must ensure thorough documentation to support the complexity of care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of extreme immaturity and its associated complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of extreme immaturity and its associated complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of extreme immaturity and its associated complications.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Frequently Asked Questions

What are the key factors to document for coding P07.21?

Key factors include the infant's gestational age, birth weight, any maternal health issues, delivery complications, and immediate postnatal care interventions.