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ICD-10 Guide
ICD-10 CodesP36.19

P36.19

Billable

Sepsis of newborn due to other streptococci

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

Code Description

ICD-10 P36.19 is a billable code used to indicate a diagnosis of sepsis of newborn due to other streptococci.

Key Diagnostic Point:

Sepsis in newborns is a critical condition characterized by a systemic inflammatory response to infection, which can lead to multi-organ dysfunction. In cases of sepsis due to other streptococci, the causative agents may include various non-group A and non-group B streptococci. Group B Streptococcus (GBS) is a well-known pathogen in neonatal sepsis, often acquired during delivery from the maternal genital tract. However, other streptococci, such as Streptococcus pneumoniae or Streptococcus viridans, can also cause sepsis in neonates, particularly in those with compromised immune systems or underlying health conditions. E. coli is another common pathogen associated with early-onset sepsis in newborns, often linked to maternal urinary tract infections or chorioamnionitis. The clinical presentation of sepsis in newborns can be subtle, including lethargy, poor feeding, temperature instability, and respiratory distress. Early recognition and prompt treatment with appropriate antibiotics are crucial to improving outcomes in affected infants.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various bacterial pathogens causing sepsis.
  • Understanding the clinical presentation and timing of sepsis onset.
  • Navigating documentation requirements for maternal infections.
  • Identifying co-morbid conditions that may complicate the diagnosis.

Audit Risk Factors

  • Inadequate documentation of the specific organism causing sepsis.
  • Failure to document maternal health history and risk factors.
  • Misclassification of sepsis as a non-infectious condition.
  • Inconsistent use of clinical indicators for sepsis diagnosis.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on the infant's condition, maternal history, and laboratory results.

Common Clinical Scenarios

Infants presenting with lethargy, temperature instability, and feeding difficulties in the NICU.

Billing Considerations

Accurate identification of the causative organism and timely initiation of treatment are critical.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination findings, including any prior infections.

Common Clinical Scenarios

Pediatric follow-up for infants discharged after treatment for sepsis.

Billing Considerations

Consideration of long-term outcomes and potential complications from sepsis.

Coding Guidelines

Inclusion Criteria

Use P36.19 When
  • Follow the ICD
  • CM guidelines for coding infections, ensuring specificity in identifying the organism
  • Document clinical indicators of sepsis, including vital signs, laboratory results, and treatment plans

Exclusion Criteria

Do NOT use P36.19 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill infant or child

Clinical Scenario

Used when a newborn with sepsis requires intensive monitoring and treatment.

Documentation Requirements

Detailed notes on the infant's clinical status, interventions, and response to treatment.

Specialty Considerations

Neonatologists must document the severity of illness and complexity of care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding neonatal sepsis, enabling better tracking of infection types and outcomes. This has implications for quality reporting and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding neonatal sepsis, enabling better tracking of infection types and outcomes. This has implications for quality reporting and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    CDC Guidelines for Neonatal Sepsis

Coding & Billing References

  • •
    CDC Guidelines for Neonatal Sepsis

Frequently Asked Questions

What are the common causes of sepsis in newborns?

Common causes include Group B Streptococcus, E. coli, and other bacterial infections. Early identification and treatment are crucial for improving outcomes.

How can I differentiate between early-onset and late-onset sepsis?

Early-onset sepsis typically occurs within the first 72 hours of life, often related to maternal infections, while late-onset sepsis occurs after 72 hours and may be associated with hospital-acquired infections.