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v1.0.0
ICD-10 Guide
ICD-10 CodesP23.0

P23.0

Billable

Congenital pneumonia due to viral agent

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

Code Description

ICD-10 P23.0 is a billable code used to indicate a diagnosis of congenital pneumonia due to viral agent.

Key Diagnostic Point:

Congenital pneumonia due to viral agents is a serious condition that occurs when a newborn is infected with a virus in utero, leading to pneumonia at birth. This condition can arise from various viral infections, including cytomegalovirus (CMV), herpes simplex virus (HSV), and respiratory syncytial virus (RSV). The pathophysiology involves the transplacental transmission of the virus, which can cause inflammation and infection in the lungs of the fetus. Symptoms may include respiratory distress, tachypnea, and hypoxia shortly after birth. Diagnosis typically involves clinical evaluation, imaging studies such as chest X-rays, and laboratory tests to identify the viral agent. Management may include supportive care, oxygen therapy, and antiviral medications depending on the causative virus. Early recognition and intervention are crucial to improve outcomes for affected neonates.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between viral and bacterial pneumonia
  • Identifying the specific viral agent responsible for pneumonia
  • Understanding the clinical presentation in neonates versus older children
  • Navigating documentation requirements for congenital conditions

Audit Risk Factors

  • Inadequate documentation of the viral agent
  • Failure to differentiate between congenital and acquired pneumonia
  • Misclassification of pneumonia type
  • Lack of supporting clinical evidence for diagnosis

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on respiratory status, imaging results, and laboratory findings are essential.

Common Clinical Scenarios

Neonates presenting with respiratory distress in the NICU, requiring oxygen support and further evaluation.

Billing Considerations

Accurate coding requires clear documentation of the timing of infection and any maternal health factors.

Pediatrics

Documentation Requirements

Documentation should include a thorough history of maternal infections and any neonatal complications.

Common Clinical Scenarios

Pediatric follow-up for neonates with a history of congenital pneumonia, assessing long-term respiratory health.

Billing Considerations

Consideration of developmental milestones and potential long-term effects of congenital pneumonia.

Coding Guidelines

Inclusion Criteria

Use P23.0 When
  • Follow the ICD
  • CM guidelines for coding congenital conditions, ensuring accurate documentation of the viral agent and clinical presentation
  • Use additional codes as necessary to capture associated conditions

Exclusion Criteria

Do NOT use P23.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

94640CPT Code

Pressurized inhalation treatment

Clinical Scenario

Used for neonates with respiratory distress due to congenital pneumonia.

Documentation Requirements

Document the indication for treatment and response to therapy.

Specialty Considerations

Neonatologists should ensure that the treatment aligns with the diagnosis of congenital pneumonia.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to track and manage neonatal respiratory infections effectively.

Resources

Clinical References

  • •
    CDC Guidelines on Neonatal Pneumonia

Coding & Billing References

  • •
    CDC Guidelines on Neonatal Pneumonia

Frequently Asked Questions

What are the common viral agents associated with congenital pneumonia?

Common viral agents include cytomegalovirus (CMV), herpes simplex virus (HSV), and respiratory syncytial virus (RSV). Each can lead to significant respiratory distress in neonates and requires specific management strategies.