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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.5

P36.5

Billable

Sepsis of newborn due to anaerobes

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

Code Description

ICD-10 P36.5 is a billable code used to indicate a diagnosis of sepsis of newborn due to anaerobes.

Key Diagnostic Point:

Sepsis in newborns due to anaerobic bacteria is a serious condition that can arise from various sources, including maternal infections during labor or delivery, or from environmental exposure postnatally. Common pathogens include Group B Streptococcus (GBS) and Escherichia coli (E. coli), which are known to cause early-onset sepsis in neonates. The clinical presentation may vary, but symptoms often include lethargy, poor feeding, temperature instability, and respiratory distress. Diagnosis typically involves blood cultures, which can identify the causative organism, and may require additional tests such as lumbar puncture if meningitis is suspected. Management includes prompt initiation of broad-spectrum intravenous antibiotics, supportive care in a neonatal intensive care unit (NICU), and monitoring for complications. Early recognition and treatment are crucial for improving outcomes in affected newborns.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between anaerobic and aerobic infections
  • Identifying the specific pathogen responsible for sepsis
  • Variability in clinical presentation among neonates
  • Need for comprehensive documentation of maternal history

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the causative organism
  • Misclassification of sepsis type (anaerobic vs. aerobic)
  • Lack of supporting lab results in the medical record

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed documentation of clinical signs, laboratory results, and treatment plans is essential. Neonatologists must ensure that all relevant maternal history is included.

Common Clinical Scenarios

Common scenarios include a newborn presenting with respiratory distress and lethargy shortly after birth, requiring immediate evaluation for sepsis.

Billing Considerations

Neonatologists should be aware of the importance of early intervention and the potential for rapid deterioration in septic newborns.

Pediatrics

Documentation Requirements

Pediatricians must document any ongoing symptoms and follow-up care for infants discharged after treatment for sepsis.

Common Clinical Scenarios

Pediatric scenarios may involve follow-up visits for infants who were treated for sepsis in the NICU, monitoring for developmental delays or other complications.

Billing Considerations

Pediatricians should consider the long-term implications of sepsis on growth and development.

Coding Guidelines

Inclusion Criteria

Use P36.5 When
  • According to ICD
  • 10 coding guidelines, P36
  • 5 should be used when the sepsis is confirmed to be due to anaerobic bacteria
  • Documentation must support the diagnosis, including clinical findings and laboratory results

Exclusion Criteria

Do NOT use P36.5 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 and complexity of care provided.

Specialty Considerations

Neonatologists should ensure that all critical care elements are documented.

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 cases effectively. It provides a clearer understanding of the causative organisms and their impact on treatment protocols.

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 cases effectively. It provides a clearer understanding of the causative organisms and their impact on treatment protocols.

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 cases effectively. It provides a clearer understanding of the causative organisms and their impact on treatment protocols.

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 anaerobic bacteria, often related to maternal infections or environmental exposure.

How is sepsis diagnosed in neonates?

Diagnosis typically involves clinical evaluation, blood cultures, and laboratory tests to identify the causative organism and assess the infant's condition.