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ICD-10 Guide
ICD-10 CodesP61.9

P61.9

Billable

Perinatal hematological disorder, unspecified

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

Code Description

ICD-10 P61.9 is a billable code used to indicate a diagnosis of perinatal hematological disorder, unspecified.

Key Diagnostic Point:

Perinatal hematological disorders encompass a range of conditions affecting the blood and blood-forming organs in newborns. These disorders can manifest as abnormalities in red blood cells, white blood cells, or platelets, leading to various clinical presentations. Common perinatal hematological disorders include thrombocytopenia, characterized by low platelet counts, which can result in increased bleeding risk, and polycythemia, where there is an excess of red blood cells, potentially leading to hyperviscosity and complications such as jaundice or respiratory distress. The unspecified nature of code P61.9 indicates that while a hematological disorder is present, the specific type or cause has not been determined. This code is often used when the clinical picture is still evolving, and further diagnostic workup is needed to clarify the underlying condition. Accurate coding is essential for appropriate management and treatment planning in the neonatal population.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of hematological disorders
  • Need for comprehensive laboratory data to specify the disorder
  • Differentiation between transient and persistent conditions
  • Potential overlap with other perinatal conditions

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify the type of hematological disorder
  • Lack of follow-up on laboratory results
  • Misuse of unspecified codes leading to potential denials

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed neonatal assessments, including blood counts and clinical observations.

Common Clinical Scenarios

Newborns presenting with jaundice, bleeding tendencies, or respiratory distress due to hematological issues.

Billing Considerations

Consideration of gestational age and birth weight, as these factors can influence hematological status.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination, including family history of hematological disorders.

Common Clinical Scenarios

Pediatric patients with a history of perinatal hematological issues presenting with complications.

Billing Considerations

Awareness of long-term follow-up needs for children with a history of perinatal hematological disorders.

Coding Guidelines

Inclusion Criteria

Use P61.9 When
  • Follow official ICD
  • 10 guidelines for coding perinatal conditions, ensuring that documentation supports the diagnosis
  • Specific criteria for newborns include gestational age, birth weight, and clinical findings

Exclusion Criteria

Do NOT use P61.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with differential

Clinical Scenario

Used to evaluate hematological status in newborns with suspected disorders.

Documentation Requirements

Document the indication for the CBC and any relevant clinical findings.

Specialty Considerations

Neonatologists should ensure that results are interpreted in the context of gestational age.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of perinatal hematological disorders, improving the ability to capture the nuances of these conditions. However, it has also increased the complexity of coding due to the need for detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal hematological disorders, improving the ability to capture the nuances of these conditions. However, it has also increased the complexity of coding due to the need for detailed documentation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal hematological disorders, improving the ability to capture the nuances of these conditions. However, it has also increased the complexity of coding due to the need for detailed documentation.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Hematology

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Hematology

Frequently Asked Questions

What should I document to support the use of code P61.9?

To support the use of code P61.9, document all relevant clinical findings, laboratory results, and any assessments that indicate a hematological disorder. Include details about the infant's gestational age, birth weight, and any interventions performed.