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ICD-10 Guide
ICD-10 CodesP07.3

P07.3

Billable

Preterm [premature] newborn [other]

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

Code Description

ICD-10 P07.3 is a billable code used to indicate a diagnosis of preterm [premature] newborn [other].

Key Diagnostic Point:

The ICD-10 code P07.3 is designated for preterm or premature newborns who are born before 37 weeks of gestation. This condition is often associated with various maternal factors such as maternal age, health status, and lifestyle choices, as well as complications during delivery. Preterm infants are at increased risk for a range of health issues, including respiratory distress syndrome, intraventricular hemorrhage, and feeding difficulties. The clinical management of preterm newborns typically occurs in a Neonatal Intensive Care Unit (NICU), where they receive specialized care to address their unique physiological needs. Factors contributing to preterm birth can include multiple gestations, infections, chronic health conditions in the mother, and complications such as placental abruption or previa. Accurate coding of P07.3 requires thorough documentation of the gestational age, any complications experienced during delivery, and the newborn's clinical status upon admission to the NICU.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in gestational age definitions and classifications
  • Need for detailed maternal history and delivery complications
  • Potential for multiple co-morbid conditions in preterm infants
  • Documentation of clinical interventions and outcomes

Audit Risk Factors

  • Inadequate documentation of gestational age
  • Failure to document maternal health factors
  • Misclassification of the type of prematurity
  • Lack of clarity in the newborn's clinical status

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of gestational age, birth weight, and any immediate complications.

Common Clinical Scenarios

Management of respiratory distress syndrome, feeding intolerance, and temperature regulation issues in the NICU.

Billing Considerations

Ensure accurate tracking of growth and development milestones for preterm infants.

Pediatrics

Documentation Requirements

Comprehensive history of maternal health and delivery complications.

Common Clinical Scenarios

Follow-up care for preterm infants with developmental delays or chronic health issues.

Billing Considerations

Consider the long-term implications of prematurity on pediatric health.

Coding Guidelines

Inclusion Criteria

Use P07.3 When
  • Follow the official ICD
  • 10 coding guidelines for perinatal conditions, ensuring accurate documentation of gestational age and any associated maternal factors or delivery complications

Exclusion Criteria

Do NOT use P07.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

Used for the initial assessment of a preterm infant in the NICU.

Documentation Requirements

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

Specialty Considerations

Neonatologists should ensure comprehensive documentation of all assessments.

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, enhancing the ability to capture the nuances of prematurity and its associated complications.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

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

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Care Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Care Guidelines

Frequently Asked Questions

What documentation is required for coding P07.3?

Documentation must include the gestational age, birth weight, any maternal health issues, and details of delivery complications. This information is crucial for accurate coding and billing.