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v1.0.0
ICD-10 Guide
ICD-10 CodesP01.1

P01.1

Billable

Newborn affected by premature rupture of membranes

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

Code Description

ICD-10 P01.1 is a billable code used to indicate a diagnosis of newborn affected by premature rupture of membranes.

Key Diagnostic Point:

Premature rupture of membranes (PROM) refers to the rupture of the amniotic sac before the onset of labor. When this occurs, it can lead to various complications for the newborn, including increased risk of infection, preterm birth, and respiratory distress syndrome. Newborns affected by PROM may present with signs of infection, such as fever or lethargy, and may require close monitoring in a neonatal intensive care unit (NICU). The timing of the rupture, gestational age at birth, and presence of any maternal complications, such as an incompetent cervix or multiple gestation, can significantly influence the clinical outcomes for these infants. Management may include antibiotics for infection prophylaxis and supportive care for respiratory or feeding difficulties. Accurate coding of this condition is crucial for appropriate treatment planning and resource allocation in neonatal care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between PROM and other causes of preterm birth
  • Documenting maternal complications accurately
  • Understanding the implications of gestational age on outcomes
  • Identifying associated conditions that may complicate care

Audit Risk Factors

  • Inadequate documentation of maternal history
  • Failure to specify the timing of membrane rupture
  • Misclassification of the newborn's clinical status
  • Omission of associated conditions or complications

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed neonatal assessments, including gestational age, clinical signs of infection, and respiratory status.

Common Clinical Scenarios

Newborns presenting with respiratory distress, requiring NICU admission for monitoring and treatment.

Billing Considerations

Close monitoring for signs of sepsis and respiratory complications, as well as the need for potential interventions such as surfactant therapy.

Pediatrics

Documentation Requirements

Comprehensive pediatric evaluations that include developmental assessments and follow-up care plans.

Common Clinical Scenarios

Pediatric follow-up for newborns with a history of PROM, focusing on growth and developmental milestones.

Billing Considerations

Consideration of long-term outcomes related to prematurity and potential developmental delays.

Coding Guidelines

Inclusion Criteria

Use P01.1 When
  • Follow the ICD
  • CM guidelines for coding perinatal conditions, ensuring that all relevant maternal and neonatal factors are documented
  • Specific attention should be paid to the gestational age and any complications that may arise from PROM

Exclusion Criteria

Do NOT use P01.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, per day, for evaluation and management of a normal newborn

Clinical Scenario

Used for newborns affected by PROM requiring initial evaluation in the NICU.

Documentation Requirements

Document the newborn's clinical status, gestational age, and any interventions performed.

Specialty Considerations

Neonatologists should ensure thorough documentation of all assessments and interventions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like PROM, improving the accuracy of data collection and reimbursement processes. 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 more specific coding of conditions like PROM, improving the accuracy of data collection and reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Care

Frequently Asked Questions

What are the key factors to document for newborns affected by PROM?

Key factors include the gestational age at the time of rupture, the duration between rupture and delivery, any signs of infection in the newborn, and the presence of maternal complications such as an incompetent cervix or multiple gestation.