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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.10

P36.10

Billable

Sepsis of newborn due to unspecified streptococci

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

Code Description

ICD-10 P36.10 is a billable code used to indicate a diagnosis of sepsis of newborn due to unspecified streptococci.

Key Diagnostic Point:

Sepsis in newborns is a serious condition characterized by a systemic inflammatory response to infection, which can lead to multi-organ dysfunction. In cases of sepsis due to unspecified streptococci, the causative organism is not clearly identified, but it is often associated with Group B Streptococcus (GBS), a common bacterium found in the gastrointestinal and genitourinary tracts of healthy adults. Newborns can acquire GBS during delivery, leading to early-onset sepsis within the first week of life. Symptoms may include lethargy, poor feeding, respiratory distress, and temperature instability. Other bacterial pathogens, such as Escherichia coli, can also cause sepsis in neonates, particularly in preterm infants or those with low birth weight. The diagnosis is typically confirmed through blood cultures, and treatment involves prompt initiation of broad-spectrum antibiotics. Early recognition and management are crucial to improving outcomes in affected newborns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between early-onset and late-onset sepsis
  • Identifying the specific bacterial pathogen when unspecified
  • Understanding the clinical presentation and risk factors for sepsis
  • Navigating documentation requirements for neonatal sepsis

Audit Risk Factors

  • Inadequate documentation of clinical signs and symptoms
  • Failure to specify the type of streptococci when known
  • Misclassification of early-onset vs. late-onset sepsis
  • Lack of supporting laboratory results in the medical record

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes including vital signs, laboratory results, and treatment plans are essential for accurate coding.

Common Clinical Scenarios

Common scenarios include a preterm infant presenting with respiratory distress and lethargy, requiring sepsis workup and management in the NICU.

Billing Considerations

Neonatologists must ensure that all relevant clinical data is documented to support the diagnosis of sepsis.

Pediatrics

Documentation Requirements

Pediatricians should document any history of maternal infection, delivery complications, and the infant's clinical course.

Common Clinical Scenarios

Pediatric scenarios may involve follow-up care for a newborn discharged after treatment for sepsis.

Billing Considerations

Consideration of the infant's growth and development post-sepsis is important for ongoing care.

Coding Guidelines

Inclusion Criteria

Use P36.10 When
  • According to ICD
  • 10 coding guidelines, sepsis codes should be used in conjunction with the underlying infection code when known
  • Documentation must support the diagnosis of sepsis, including clinical signs, laboratory findings, and treatment

Exclusion Criteria

Do NOT use P36.10 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill infant

Clinical Scenario

Used when a newborn with sepsis requires intensive monitoring and management in the NICU.

Documentation Requirements

Documentation must include time spent, clinical condition, and interventions performed.

Specialty Considerations

Neonatologists should ensure that all critical care services are well-documented to support billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. The granularity of ICD-10 codes helps in understanding the epidemiology of sepsis in newborns and facilitates better clinical management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. The granularity of ICD-10 codes helps in understanding the epidemiology of sepsis in newborns and facilitates better clinical management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. The granularity of ICD-10 codes helps in understanding the epidemiology of sepsis in newborns and facilitates better clinical management.

Resources

Clinical References

  • •
    CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Coding & Billing References

  • •
    CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Frequently Asked Questions

What are the common symptoms of sepsis in newborns?

Common symptoms include lethargy, poor feeding, temperature instability, respiratory distress, and irritability. Early recognition is crucial for effective management.