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ICD-10 Guide
ICD-10 CodesP07.25

P07.25

Billable

Extreme immaturity of newborn, gestational age 26 completed weeks

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

Code Description

ICD-10 P07.25 is a billable code used to indicate a diagnosis of extreme immaturity of newborn, gestational age 26 completed weeks.

Key Diagnostic Point:

Extreme immaturity of a newborn, classified under ICD-10 code P07.25, refers to infants born at a gestational age of 26 completed weeks or earlier. These infants are at a significantly increased risk for a variety of complications due to their underdeveloped organ systems. Common issues include respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. The management of these infants often requires specialized care in a Neonatal Intensive Care Unit (NICU), where they may receive interventions such as mechanical ventilation, surfactant therapy, and nutritional support. Maternal factors such as preterm labor, infections, and placental insufficiency can contribute to extreme prematurity. Delivery complications, including emergency cesarean sections and prolonged rupture of membranes, may also play a role in the birth of these extremely immature infants. The prognosis for these newborns varies widely, depending on the presence of comorbidities and the quality of neonatal care provided.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation and associated conditions
  • Need for detailed documentation of maternal and delivery complications
  • Potential for multiple co-morbidities requiring additional coding
  • Frequent updates to coding guidelines and clinical practices

Audit Risk Factors

  • Inadequate documentation of gestational age
  • Failure to capture associated conditions or complications
  • Misclassification of the severity of immaturity
  • Inconsistent coding practices across different healthcare providers

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of gestational age, birth weight, and any complications during delivery or postnatal care.

Common Clinical Scenarios

Infants requiring respiratory support, those with feeding intolerance, and those experiencing temperature instability.

Billing Considerations

Accurate coding requires understanding of the infant's clinical course and any interventions provided.

Pediatrics

Documentation Requirements

Comprehensive history of perinatal events, including maternal health and delivery details.

Common Clinical Scenarios

Follow-up visits for developmental assessments and management of chronic conditions stemming from prematurity.

Billing Considerations

Pediatricians must be aware of the long-term implications of extreme prematurity on growth and development.

Coding Guidelines

Inclusion Criteria

Use P07.25 When
  • Perinatal coding guidelines emphasize the importance of accurately documenting gestational age, birth weight, and any complications during delivery
  • Coders should ensure that all relevant maternal factors and delivery complications are captured to support the use of P07

Exclusion Criteria

Do NOT use P07.25 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 infant.

Clinical Scenario

Used for the initial assessment of a newborn at 26 weeks gestation in the NICU.

Documentation Requirements

Document the infant's gestational age, weight, and any immediate interventions required.

Specialty Considerations

Neonatologists must ensure that all aspects of care are documented to support the complexity of the case.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including extreme immaturity. This specificity helps 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 perinatal conditions, including extreme immaturity. This specificity helps in better tracking of outcomes and resource utilization in neonatal care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including extreme immaturity. This specificity helps in better tracking of outcomes and resource utilization in neonatal care.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Frequently Asked Questions

What are the key factors to consider when coding for extreme immaturity?

Key factors include accurate documentation of gestational age, birth weight, and any associated complications. Coders should also be aware of maternal factors that may have contributed to the infant's condition.