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ICD-10 Guide
ICD-10 CodesP23.2

P23.2

Billable

Congenital pneumonia due to staphylococcus

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

Code Description

ICD-10 P23.2 is a billable code used to indicate a diagnosis of congenital pneumonia due to staphylococcus.

Key Diagnostic Point:

Congenital pneumonia due to staphylococcus is a serious neonatal condition characterized by the presence of pneumonia in a newborn that is acquired in utero. This condition is typically caused by Staphylococcus aureus, which can be transmitted from the mother to the fetus during pregnancy or delivery. The clinical presentation may include respiratory distress, tachypnea, and hypoxia shortly after birth. Diagnosis is often confirmed through clinical evaluation, imaging studies such as chest X-rays, and microbiological cultures. Treatment usually involves the administration of appropriate antibiotics and supportive care in a neonatal intensive care unit (NICU). Early recognition and intervention are crucial to improve outcomes, as congenital pneumonia can lead to significant morbidity and mortality if not addressed promptly. The condition is part of a broader category of neonatal respiratory infections, which can also include intrauterine pneumonia and other infectious processes affecting the lungs of newborns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital pneumonia and other types of pneumonia.
  • Understanding the specific causative organism and its implications for treatment.
  • Navigating the documentation requirements for maternal and neonatal health.
  • Identifying associated conditions that may complicate the clinical picture.

Audit Risk Factors

  • Inadequate documentation of maternal infection history.
  • Failure to specify the causative organism.
  • Misclassification of pneumonia type.
  • Lack of supporting clinical evidence for diagnosis.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed documentation of respiratory status, treatment protocols, and response to therapy.

Common Clinical Scenarios

Newborns presenting with respiratory distress in the NICU, requiring immediate intervention.

Billing Considerations

Consideration of maternal health factors, such as chorioamnionitis or other infections.

Pediatrics

Documentation Requirements

Thorough history and physical examination, including maternal health and delivery details.

Common Clinical Scenarios

Follow-up visits for infants with a history of congenital pneumonia.

Billing Considerations

Monitoring for long-term respiratory complications in affected infants.

Coding Guidelines

Inclusion Criteria

Use P23.2 When
  • Coders should adhere to official ICD
  • 10 guidelines, ensuring accurate documentation of the diagnosis, treatment, and any associated conditions
  • Specific criteria for neonatal pneumonia must be met, including clinical signs, imaging results, and microbiological confirmation

Exclusion Criteria

Do NOT use P23.2 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 when a newborn with congenital pneumonia requires initial evaluation and management.

Documentation Requirements

Documentation of the newborn's clinical status, including respiratory assessment.

Specialty Considerations

Neonatologists should ensure comprehensive documentation of the infant's condition and treatment plan.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively. This specificity aids in better understanding epidemiology and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively. This specificity aids in better understanding epidemiology and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively. This specificity aids in better understanding epidemiology and treatment outcomes.

Resources

Clinical References

  • •
    CDC Guidelines for Neonatal Pneumonia

Coding & Billing References

  • •
    CDC Guidelines for Neonatal Pneumonia

Frequently Asked Questions

What are the common symptoms of congenital pneumonia in newborns?

Common symptoms include respiratory distress, tachypnea, grunting, and cyanosis. Early identification and treatment are critical for improving outcomes.