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v1.0.0
ICD-10 Guide
ICD-10 CodesP54.0

P54.0

Billable

Neonatal hematemesis

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

Code Description

ICD-10 P54.0 is a billable code used to indicate a diagnosis of neonatal hematemesis.

Key Diagnostic Point:

Neonatal hematemesis refers to the vomiting of blood in newborns, which can be a sign of underlying gastrointestinal bleeding. This condition may arise from various etiologies, including but not limited to, esophageal varices, gastric ulcers, or trauma. In neonates, the presence of hematemesis can indicate significant morbidity and requires prompt evaluation. The differential diagnosis may include conditions such as necrotizing enterocolitis, which is more common in premature infants, or congenital anomalies of the gastrointestinal tract. The clinical presentation may vary, with some infants exhibiting signs of distress, while others may appear stable. Diagnostic workup often includes imaging studies and endoscopy, depending on the clinical scenario. Management may involve supportive care, fluid resuscitation, and addressing the underlying cause of the bleeding. Early recognition and intervention are crucial to prevent complications such as hypovolemic shock or anemia.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes requiring differential diagnosis
  • Need for detailed documentation of clinical findings and interventions
  • Variability in presentation and severity among neonates
  • Potential for co-existing conditions that complicate coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the source of bleeding
  • Misclassification of the severity of the condition
  • Omission of relevant co-morbidities

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes including vital signs, feeding history, and any interventions performed.

Common Clinical Scenarios

Infants presenting with hematemesis in the NICU, often requiring immediate evaluation and management.

Billing Considerations

Consideration of gestational age and birth weight, as these factors can influence the risk of gastrointestinal bleeding.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination, including dietary intake and any prior medical history.

Common Clinical Scenarios

Pediatric patients with a history of perinatal complications presenting with gastrointestinal symptoms.

Billing Considerations

Awareness of developmental milestones and how they may relate to the presentation of hematemesis.

Coding Guidelines

Inclusion Criteria

Use P54.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring specificity in documentation regarding the source and severity of bleeding
  • Utilize additional codes for any co
  • existing conditions

Exclusion Criteria

Do NOT use P54.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the neonate

Clinical Scenario

Used when a neonate with hematemesis requires intensive monitoring and intervention.

Documentation Requirements

Detailed documentation of critical care services provided.

Specialty Considerations

Neonatologists must ensure accurate reporting of time spent and services rendered.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding neonatal conditions, including hematemesis. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding neonatal conditions, including hematemesis. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding neonatal conditions, including hematemesis. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Hematemesis Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Hematemesis Guidelines

Frequently Asked Questions

What are the common causes of neonatal hematemesis?

Common causes include congenital anomalies, trauma, infections, and conditions like necrotizing enterocolitis. Each case requires thorough evaluation to determine the underlying cause.