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v1.0.0
ICD-10 Guide
ICD-10 CodesChapter 16: Certain conditions originating in the perinatal periodP38

P38

Billable

Omphalitis of newborn

Chapter 16:Certain conditions originating in the perinatal period

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

Code Description

ICD-10 P38 is a billable code used to indicate a diagnosis of omphalitis of newborn.

Key Diagnostic Point:

Omphalitis is an infection of the umbilical stump that occurs in newborns, typically within the first week of life. It is characterized by inflammation, redness, and discharge at the site of the umbilical cord. The condition can arise from various factors, including poor hygiene, contamination during delivery, or inadequate care of the umbilical stump. Omphalitis can lead to serious complications such as sepsis, which may require hospitalization and intensive care. The infection is often caused by bacteria, including Staphylococcus aureus and Escherichia coli. Clinical signs may include fever, irritability, and feeding difficulties. Early recognition and treatment are crucial to prevent progression to systemic infection. Management typically involves antibiotic therapy and, in severe cases, surgical intervention may be necessary to remove necrotic tissue. Proper care of the umbilical cord stump, including keeping it clean and dry, is essential in preventing omphalitis in newborns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between omphalitis and other umbilical cord-related conditions.
  • Understanding the clinical presentation and severity of the infection.
  • Documenting associated complications such as sepsis or necrotizing fasciitis.
  • Navigating coding guidelines for infections in neonates.

Audit Risk Factors

  • Inadequate documentation of clinical findings.
  • Failure to document the onset and duration of symptoms.
  • Misclassification of the severity of the infection.
  • Lack of clarity on the treatment provided.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on the presentation, treatment, and response to therapy are essential.

Common Clinical Scenarios

A newborn presents with a red, swollen umbilical stump and fever, requiring evaluation in the NICU.

Billing Considerations

Neonatologists must document the timing of the infection and any interventions performed.

Pediatrics

Documentation Requirements

Pediatricians should document the history of umbilical cord care and any parental education provided.

Common Clinical Scenarios

A pediatric follow-up visit for a newborn with a history of omphalitis.

Billing Considerations

Consideration of long-term outcomes and potential complications in follow-up care.

Coding Guidelines

Inclusion Criteria

Use P38 When
  • Follow the ICD
  • CM guidelines for coding infections, ensuring that the diagnosis is supported by clinical documentation
  • Specific criteria for omphalitis include the presence of inflammation and discharge at the umbilical site, along with systemic signs of infection

Exclusion Criteria

Do NOT use P38 When
No specific exclusions found.

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill infant.

Clinical Scenario

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

Documentation Requirements

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

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 omphalitis, enabling better tracking of infection rates and outcomes in newborns. This specificity aids in research and quality improvement initiatives.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of omphalitis, enabling better tracking of infection rates and outcomes in newborns. This specificity aids in research and quality improvement initiatives.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of omphalitis, enabling better tracking of infection rates and outcomes in newborns. This specificity aids in research and quality improvement initiatives.

Resources

Clinical References

  • •
    CDC Guidelines for Umbilical Cord Care

Coding & Billing References

  • •
    CDC Guidelines for Umbilical Cord Care

Frequently Asked Questions

What are the common signs of omphalitis in newborns?

Common signs include redness, swelling, and discharge at the umbilical stump, along with systemic signs such as fever and irritability.

How is omphalitis treated in newborns?

Treatment typically involves antibiotic therapy and, in severe cases, surgical intervention to remove necrotic tissue.