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v1.0.0
ICD-10 Guide
DiagnosesPeriventricular Leukomalacia

Periventricular Leukomalacia

ICD-10 Coding for Periventricular Leukomalacia(P91.2)

PRIMARY SPECIALTYNeonatology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Periventricular Leukomalacia?
Essential facts and insights about Periventricular Leukomalacia

Key Clinical Considerations:

  • Neurological deficits such as spasticity, seizures, and developmental delays
  • MRI findings showing periventricular white matter injury
  • Signs of cerebral palsy or motor impairment during physical examination

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including gestational age and birth weight
  • Neurological assessment results and imaging reports
  • Detailed description of motor function and developmental milestones

Coding Guidelines

Usage Guidelines & Examples

  • Follow ICD-10 guidelines for coding neurological conditions.
  • Common errors include misclassifying the severity or type of brain injury.

Code Exclusions

Important Exclusions

  • Other types of white matter injury such as diffuse axonal injury
  • Alternative codes for cerebral palsy or other neurological disorders

Related ICD-10 Codes

Primary Codes
P91.5
Periventricular leukomalacia
Ancillary Codes
G80.9
Z38.2
Differential Codes
P91.9
P91.2
for confirmed PVL;
P91.9
is for unspecified disturbances.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Neonatology

Specialty Applications

  • Neonates with a history of prematurity or hypoxic-ischemic injury
  • Neonatal intensive care units (NICUs) and pediatric neurology clinics

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What are the documentation requirements?

Document clinical findings, imaging results, and developmental assessments.

What are the billing considerations?

Ensure accurate coding based on clinical documentation and follow payer guidelines.