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ICD-10 Guide
ICD-10 CodesP23.4

P23.4

Billable

Congenital pneumonia due to Escherichia coli

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

Code Description

ICD-10 P23.4 is a billable code used to indicate a diagnosis of congenital pneumonia due to escherichia coli.

Key Diagnostic Point:

Congenital pneumonia due to Escherichia coli is a serious neonatal condition characterized by the presence of pneumonia in a newborn that is caused by the bacterium Escherichia coli (E. coli). This condition typically arises when the bacteria are transmitted from the mother to the fetus during pregnancy, often due to intrauterine infection or chorioamnionitis. Newborns with congenital pneumonia may present with respiratory distress, tachypnea, grunting, and cyanosis shortly after birth. Diagnosis is confirmed through clinical evaluation, imaging studies such as chest X-rays, and microbiological cultures. Treatment usually involves the administration of appropriate antibiotics and supportive care in a neonatal intensive care unit (NICU). Early recognition and management are crucial to improve outcomes, as untreated congenital pneumonia can lead to severe complications, including respiratory failure and sepsis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital pneumonia and other types of pneumonia.
  • Understanding the maternal history and risk factors for E. coli transmission.
  • Accurate documentation of clinical signs and symptoms.
  • Navigating the coding guidelines for pneumonia in neonates.

Audit Risk Factors

  • Inadequate documentation of maternal infection history.
  • Failure to specify the causative organism.
  • Misclassification of pneumonia type.
  • Lack of supporting clinical evidence for diagnosis.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on respiratory status, treatment protocols, and response to therapy.

Common Clinical Scenarios

Newborns presenting with respiratory distress in the NICU, requiring immediate intervention.

Billing Considerations

Ensure accurate coding of associated conditions such as sepsis or respiratory failure.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination, including maternal health and delivery details.

Common Clinical Scenarios

Follow-up visits for newborns with a history of congenital pneumonia.

Billing Considerations

Consider the long-term implications of congenital pneumonia on respiratory health.

Coding Guidelines

Inclusion Criteria

Use P23.4 When
  • Follow the official ICD
  • CM coding guidelines for pneumonia, ensuring specificity in the diagnosis and adherence to documentation standards for neonatal conditions

Exclusion Criteria

Do NOT use P23.4 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 when a newborn with congenital pneumonia is admitted for evaluation.

Documentation Requirements

Document the newborn's clinical status, including respiratory assessment.

Specialty Considerations

Neonatologists should ensure thorough documentation of the newborn's condition and treatment plan.

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 accuracy of data collection and reimbursement processes for neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the accuracy of data collection and reimbursement processes for neonatal care.

Reimbursement & Billing Impact

reimbursement processes for neonatal care.

Resources

Clinical References

  • •
    CDC Guidelines for Neonatal Pneumonia

Coding & Billing References

  • •
    CDC Guidelines for Neonatal Pneumonia

Frequently Asked Questions

What are the common causes of congenital pneumonia?

Congenital pneumonia can be caused by various pathogens, with Escherichia coli being a significant contributor, especially in cases associated with maternal infections during pregnancy.