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v1.0.0
ICD-10 Guide
ICD-10 CodesP23.3

P23.3

Billable

Congenital pneumonia due to streptococcus, group B

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

Code Description

ICD-10 P23.3 is a billable code used to indicate a diagnosis of congenital pneumonia due to streptococcus, group b.

Key Diagnostic Point:

Congenital pneumonia due to Group B Streptococcus (GBS) is a significant cause of neonatal morbidity and mortality. This condition arises when the bacteria are transmitted from the mother to the fetus during pregnancy or delivery, leading to infection in the newborn. GBS can colonize the maternal genital tract and, if present, can infect the newborn either in utero or during passage through the birth canal. Clinical manifestations of congenital pneumonia may include respiratory distress, tachypnea, grunting, and cyanosis shortly after birth. Diagnosis is typically confirmed through clinical evaluation and laboratory tests, including blood cultures and chest X-rays. Early recognition and treatment are crucial, as untreated GBS pneumonia can lead to severe complications, including sepsis and long-term neurological impairment. Management often involves the administration of intravenous antibiotics and supportive care in a neonatal intensive care unit (NICU).

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital pneumonia and other neonatal respiratory infections.
  • Understanding the timing of infection (intrauterine vs. perinatal).
  • Documentation of maternal GBS status and its implications.
  • Variability in clinical presentation among affected newborns.

Audit Risk Factors

  • Inadequate documentation of maternal GBS screening results.
  • Failure to document the onset of symptoms in the newborn.
  • Misclassification of pneumonia type (congenital vs. acquired).
  • Lack of supporting laboratory results.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed documentation of respiratory assessment, maternal history, and treatment protocols.

Common Clinical Scenarios

Newborn presenting with respiratory distress shortly after birth, requiring NICU admission for management.

Billing Considerations

Consideration of other potential causes of pneumonia and the need for timely intervention.

Pediatrics

Documentation Requirements

Comprehensive history including maternal health, delivery details, and newborn assessment.

Common Clinical Scenarios

Follow-up visits for newborns with a history of GBS pneumonia, monitoring for long-term effects.

Billing Considerations

Awareness of potential developmental delays or complications stemming from early infection.

Coding Guidelines

Inclusion Criteria

Use P23.3 When
  • Follow the official ICD
  • CM guidelines for coding pneumonia, ensuring accurate documentation of the cause and timing of the infection
  • Specific criteria for congenital conditions must be met, including maternal history and clinical presentation

Exclusion Criteria

Do NOT use P23.3 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 when a newborn with congenital pneumonia is evaluated in the NICU.

Documentation Requirements

Document the clinical assessment, treatment plan, and any interventions performed.

Specialty Considerations

Neonatologists should ensure comprehensive documentation of respiratory assessments.

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 cases of GBS pneumonia in newborns.

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 cases of GBS pneumonia in newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage cases of GBS pneumonia in newborns.

Resources

Clinical References

  • •
    CDC Guidelines for Group B Streptococcus

Coding & Billing References

  • •
    CDC Guidelines for Group B Streptococcus

Frequently Asked Questions

What is the significance of maternal GBS screening?

Maternal GBS screening is crucial as it helps identify mothers at risk of transmitting the bacteria to their newborns, allowing for timely antibiotic prophylaxis during labor to reduce the incidence of congenital pneumonia.