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v1.0.0
ICD-10 Guide
ICD-10 CodesP07.31

P07.31

Billable

Preterm newborn, gestational age 28 completed weeks

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

Code Description

ICD-10 P07.31 is a billable code used to indicate a diagnosis of preterm newborn, gestational age 28 completed weeks.

Key Diagnostic Point:

P07.31 refers to a preterm newborn who has been delivered at 28 completed weeks of gestation. This classification is critical as infants born at this gestational age are at a significantly higher risk for various complications, including respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. The care for these infants often requires admission to a Neonatal Intensive Care Unit (NICU) for specialized monitoring and interventions. Maternal factors such as preeclampsia, infections, or multiple gestations can contribute to preterm delivery, necessitating a thorough review of maternal health history. Delivery complications, including uterine rupture or placental abruption, may also play a role in the premature birth of the infant. Accurate coding is essential for appropriate reimbursement and to ensure that the newborn receives the necessary level of care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation and complications associated with preterm birth.
  • Need for detailed maternal history and delivery complications documentation.
  • Potential for multiple co-morbidities requiring additional coding.
  • Differentiation between various gestational ages and their associated risks.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to capture all co-morbidities associated with preterm birth.
  • Misclassification of gestational age.
  • Lack of detailed notes on delivery complications.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of neonatal assessments, interventions, and outcomes.

Common Clinical Scenarios

Management of respiratory distress syndrome, monitoring for signs of infection, and nutritional support.

Billing Considerations

Consideration of long-term follow-up for developmental outcomes.

Pediatrics

Documentation Requirements

Comprehensive pediatric evaluations, including growth and developmental assessments.

Common Clinical Scenarios

Follow-up care for preterm infants, addressing potential developmental delays.

Billing Considerations

Coordination with specialists for ongoing care and monitoring.

Coding Guidelines

Inclusion Criteria

Use P07.31 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and associated complications

Exclusion Criteria

Do NOT use P07.31 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

Clinical Scenario

Used for 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 preterm conditions, improving the ability to capture the complexity of care required for these infants.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of preterm conditions, improving the ability to capture the complexity of care required for these infants.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of preterm conditions, improving the ability to capture the complexity of care required for these infants.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Care

Frequently Asked Questions

What are the common complications associated with a preterm newborn at 28 weeks?

Common complications include respiratory distress syndrome, intraventricular hemorrhage, feeding difficulties, and increased risk of infections. These infants require close monitoring and specialized care to manage these risks effectively.