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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.2

P36.2

Billable

Sepsis of newborn due to Staphylococcus aureus

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

Code Description

ICD-10 P36.2 is a billable code used to indicate a diagnosis of sepsis of newborn due to staphylococcus aureus.

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. Staphylococcus aureus is a common pathogen responsible for early-onset sepsis, particularly in neonates. This bacterium can be transmitted from the mother during delivery or through contact with healthcare providers. Clinical manifestations may include lethargy, poor feeding, temperature instability, respiratory distress, and hypotension. Diagnosis is typically confirmed through blood cultures and clinical evaluation. Early recognition and treatment are crucial, as sepsis can rapidly progress to severe illness or death. Treatment usually involves intravenous antibiotics, supportive care, and monitoring in a neonatal intensive care unit (NICU). Other common pathogens associated with neonatal sepsis include Group B Streptococcus and Escherichia coli, which also require prompt identification and management to improve outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between early-onset and late-onset sepsis.
  • Identifying the specific causative organism from blood cultures.
  • Understanding the clinical presentation and management protocols.
  • Navigating the documentation requirements for NICU admissions.

Audit Risk Factors

  • Inadequate documentation of clinical signs and symptoms.
  • Failure to specify the causative organism.
  • Misclassification of sepsis type (early vs. late onset).
  • 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.

Common Clinical Scenarios

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

Billing Considerations

Accurate coding requires understanding of sepsis management protocols and the importance of timely intervention.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination, including maternal history and delivery details.

Common Clinical Scenarios

Pediatric follow-up for infants discharged from the NICU with a history of sepsis.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use P36.2 When
  • Follow the ICD
  • CM guidelines for coding infections and sepsis, ensuring specificity in the causative organism and clinical context
  • Documentation must support the diagnosis and treatment provided

Exclusion Criteria

Do NOT use P36.2 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 management.

Documentation Requirements

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

Specialty Considerations

Neonatologists must document the severity of illness and rationale for critical care services.

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, improving the ability to track and manage these conditions effectively. The detailed codes help in understanding the epidemiology and outcomes of sepsis in newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding neonatal sepsis, improving the ability to track and manage these conditions effectively. The detailed codes help in understanding the epidemiology and outcomes of sepsis in newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding neonatal sepsis, improving the ability to track and manage these conditions effectively. The detailed codes help in understanding the epidemiology and outcomes of sepsis in newborns.

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 signs of sepsis in newborns?

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