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v1.0.0
ICD-10 Guide
ICD-10 CodesP07.38

P07.38

Billable

Preterm newborn, gestational age 35 completed weeks

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

Code Description

ICD-10 P07.38 is a billable code used to indicate a diagnosis of preterm newborn, gestational age 35 completed weeks.

Key Diagnostic Point:

P07.38 refers to a preterm newborn who has reached a gestational age of 35 completed weeks. This classification is crucial as it highlights the infant's increased risk for various health complications due to being born before the full term of 37 weeks. Newborns in this category may experience respiratory distress syndrome, feeding difficulties, and temperature regulation issues. Maternal factors such as hypertension, diabetes, or infections during pregnancy can contribute to preterm birth. Delivery complications, including placental abruption or preterm premature rupture of membranes (PPROM), can also lead to this condition. Close monitoring and specialized care in a neonatal intensive care unit (NICU) are often required to address these potential complications and ensure optimal outcomes for the infant.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of preterm infants
  • Need for detailed maternal history to identify risk factors
  • Potential for multiple coexisting conditions requiring additional coding
  • Documentation of gestational age and delivery complications

Audit Risk Factors

  • Inaccurate documentation of gestational age
  • Failure to capture maternal health conditions
  • Misclassification of the infant's condition at discharge
  • Inconsistent coding of associated complications

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of the infant's clinical status, including weight, Apgar scores, and any interventions required.

Common Clinical Scenarios

Management of respiratory distress, feeding intolerance, and temperature instability in the NICU.

Billing Considerations

Accurate coding requires understanding of the infant's gestational age and any maternal factors that may have contributed to preterm birth.

Pediatrics

Documentation Requirements

Comprehensive follow-up notes detailing growth, development, and any ongoing health issues stemming from prematurity.

Common Clinical Scenarios

Pediatric assessments for developmental delays or chronic health issues related to being born preterm.

Billing Considerations

Pediatric coders must be aware of the long-term implications of prematurity on health outcomes.

Coding Guidelines

Inclusion Criteria

Use P07.38 When
  • Coders should adhere to the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and any maternal factors
  • It is essential to capture all relevant complications and coexisting conditions to provide a complete clinical picture

Exclusion Criteria

Do NOT use P07.38 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 initial assessment of a preterm infant in the NICU.

Documentation Requirements

Documentation of the infant's clinical status and any interventions performed.

Specialty Considerations

Neonatologists must ensure thorough documentation to support the complexity of care provided.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of preterm conditions, improving the ability to capture the nuances of neonatal care and associated complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of preterm conditions, improving the ability to capture the nuances of neonatal care and associated complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of preterm conditions, improving the ability to capture the nuances of neonatal care and associated complications.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Frequently Asked Questions

What is the significance of coding P07.38 accurately?

Accurate coding of P07.38 is essential for proper reimbursement, tracking of neonatal outcomes, and ensuring that infants receive appropriate care based on their gestational age and associated risks.