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v1.0.0
ICD-10 Guide
ICD-10 CodesP09

P09

Billable

Abnormal findings on neonatal screening

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

Code Description

ICD-10 P09 is a billable code used to indicate a diagnosis of abnormal findings on neonatal screening.

Key Diagnostic Point:

Abnormal findings on neonatal screening (ICD-10 code P09) encompass a range of conditions identified during routine screening tests performed on newborns shortly after birth. These screenings are crucial for early detection of metabolic, genetic, and infectious diseases that can significantly impact a newborn's health if left untreated. Common conditions screened include phenylketonuria (PKU), congenital hypothyroidism, and cystic fibrosis. Maternal factors such as diabetes, infections, and substance use during pregnancy can contribute to abnormal findings. Delivery complications, including asphyxia or preterm birth, may also lead to abnormal screening results. Accurate coding of these findings is essential for appropriate management and follow-up care, as well as for ensuring that healthcare providers receive proper reimbursement for the services rendered. Coders must be vigilant in documenting the specific abnormalities identified and any related maternal or delivery complications to ensure comprehensive coding.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions that can be screened and coded under P09.
  • Need for detailed documentation of maternal history and delivery complications.
  • Potential for overlapping symptoms with other neonatal conditions.
  • Variability in screening protocols across different healthcare settings.

Audit Risk Factors

  • Inadequate documentation of maternal health factors.
  • Failure to link abnormal findings to specific delivery complications.
  • Misclassification of screening results leading to incorrect coding.
  • Lack of follow-up documentation for confirmed diagnoses.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of neonatal screening results, maternal health history, and any complications during delivery.

Common Clinical Scenarios

Newborns presenting with abnormal metabolic screening results in the NICU, requiring immediate intervention.

Billing Considerations

Coders must ensure that all relevant maternal and delivery factors are documented to support the coding of P09.

Pediatrics

Documentation Requirements

Comprehensive pediatric history including any follow-up care related to abnormal screening results.

Common Clinical Scenarios

Pediatric visits for follow-up on newborn screening results, including referrals to specialists.

Billing Considerations

Consideration of long-term management plans for conditions identified through neonatal screening.

Coding Guidelines

Inclusion Criteria

Use P09 When
  • Coders should adhere to official ICD
  • 10 guidelines, ensuring that all relevant clinical information is documented
  • This includes maternal health factors, delivery complications, and specific abnormal findings from neonatal screening tests
  • Accurate coding requires understanding the nuances of each condition screened

Exclusion Criteria

Do NOT use P09 When
No specific exclusions found.

Related CPT Codes

81200CPT Code

Genetic testing for metabolic disorders

Clinical Scenario

Used when abnormal screening results necessitate further genetic evaluation.

Documentation Requirements

Documentation of screening results and rationale for genetic testing.

Specialty Considerations

Neonatologists must ensure that all relevant clinical information is included to support the necessity of testing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of abnormal findings, improving the ability to track and manage neonatal conditions. This specificity aids in better patient care and more accurate reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of abnormal findings, improving the ability to track and manage neonatal conditions. This specificity aids in better patient care and more accurate reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Screening

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Screening

Frequently Asked Questions

What are the common conditions screened for under code P09?

Common conditions include metabolic disorders like phenylketonuria (PKU), congenital hypothyroidism, and cystic fibrosis. Each of these conditions has specific screening protocols and follow-up requirements.