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ICD-10 Guide
ICD-10 CodesP09.1

P09.1

Billable

Abnormal findings on neonatal screening for inborn errors of metabolism

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

Code Description

ICD-10 P09.1 is a billable code used to indicate a diagnosis of abnormal findings on neonatal screening for inborn errors of metabolism.

Key Diagnostic Point:

P09.1 refers to abnormal findings identified during neonatal screening tests that are designed to detect inborn errors of metabolism (IEM). These conditions are genetic disorders that affect the body's ability to metabolize certain substances, leading to potentially serious health issues if not diagnosed and treated early. Common IEMs include phenylketonuria (PKU), galactosemia, and maple syrup urine disease. The screening typically occurs within the first few days of life, utilizing blood samples collected via heel prick. Abnormal results necessitate further diagnostic testing and immediate clinical intervention to prevent complications such as developmental delays, organ damage, or metabolic crises. Maternal factors, such as maternal diabetes or certain medications taken during pregnancy, can influence the risk of IEMs in newborns. Additionally, delivery complications, including asphyxia or prematurity, may complicate the clinical picture and necessitate a multidisciplinary approach to care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in screening protocols across states and institutions
  • Need for timely follow-up testing and intervention
  • Potential for multiple abnormal findings requiring differential diagnosis
  • Documentation of maternal history and delivery complications

Audit Risk Factors

  • Inadequate documentation of screening results and follow-up actions
  • Failure to capture maternal health history impacting newborn outcomes
  • Misclassification of abnormal findings as normal
  • Lack of detailed notes on the clinical rationale for further testing

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of screening results, follow-up tests, and clinical interventions.

Common Clinical Scenarios

Newborns presenting with abnormal metabolic screening results requiring NICU admission for further evaluation.

Billing Considerations

Ensure accurate coding of both the abnormal findings and any related complications or interventions.

Pediatrics

Documentation Requirements

Comprehensive documentation of ongoing management and follow-up care for diagnosed metabolic disorders.

Common Clinical Scenarios

Pediatric patients with confirmed inborn errors of metabolism requiring dietary management or pharmacological treatment.

Billing Considerations

Consider the long-term implications of IEMs on growth and development in pediatric coding.

Coding Guidelines

Inclusion Criteria

Use P09.1 When
  • Follow the official ICD
  • CM guidelines for coding and reporting, ensuring that all relevant clinical information is documented
  • Specific criteria for neonatal screening and follow
  • up must be adhered to, including the timing of screenings and the necessity for further diagnostic testing

Exclusion Criteria

Do NOT use P09.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81200CPT Code

Genetic testing for metabolic disorders

Clinical Scenario

Used when abnormal findings on neonatal screening necessitate further genetic evaluation.

Documentation Requirements

Document the rationale for testing and any prior screening results.

Specialty Considerations

Neonatologists should ensure that genetic counseling is part of the care plan.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of inborn errors of metabolism, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of these conditions for public health purposes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of inborn errors of metabolism, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of these conditions for public health purposes.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of these conditions for public health purposes.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Newborn Screening

Coding & Billing References

  • •
    American Academy of Pediatrics - Newborn Screening

Frequently Asked Questions

What are the implications of abnormal neonatal screening results?

Abnormal neonatal screening results indicate potential inborn errors of metabolism that require immediate follow-up testing and intervention. Early diagnosis and management are crucial to prevent serious health complications.