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v1.0.0
ICD-10 Guide
ICD-10 CodesP23.5

P23.5

Billable

Congenital pneumonia due to Pseudomonas

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

Code Description

ICD-10 P23.5 is a billable code used to indicate a diagnosis of congenital pneumonia due to pseudomonas.

Key Diagnostic Point:

Congenital pneumonia due to Pseudomonas is a serious neonatal condition characterized by the presence of pneumonia in a newborn that is caused by the bacterium Pseudomonas aeruginosa. This condition typically arises when the pathogen is transmitted from the mother to the fetus during pregnancy, often due to maternal infections or colonization. The clinical presentation may include 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. Management often requires intensive care, including oxygen therapy, mechanical ventilation, and antibiotic treatment tailored to the specific pathogen. Early recognition and intervention are crucial to improve outcomes, as congenital pneumonia can lead to significant morbidity and mortality in neonates.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between congenital and acquired pneumonia
  • Identifying the specific pathogen responsible for pneumonia
  • Understanding maternal health history and its impact on neonatal outcomes
  • Navigating the nuances of coding for respiratory conditions in neonates

Audit Risk Factors

  • Inadequate documentation of maternal infections
  • Failure to specify the causative organism
  • Misclassification of pneumonia type (congenital vs. acquired)
  • Lack of detailed clinical notes on respiratory assessment

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Neonatal documentation must include detailed respiratory assessments, maternal health history, and treatment plans.

Common Clinical Scenarios

Common scenarios include premature infants with respiratory distress and full-term infants presenting with signs of infection.

Billing Considerations

Neonatologists must ensure that all clinical findings are documented to support the diagnosis of congenital pneumonia.

Pediatrics

Documentation Requirements

Pediatric documentation should reflect ongoing assessments and management of respiratory conditions stemming from perinatal issues.

Common Clinical Scenarios

Pediatricians may encounter cases where congenital pneumonia leads to long-term respiratory issues requiring follow-up.

Billing Considerations

Pediatric coding must accurately reflect the history of the condition and any interventions performed.

Coding Guidelines

Inclusion Criteria

Use P23.5 When
  • Official coding guidelines for P23
  • 5 emphasize the importance of accurate documentation of the clinical presentation, laboratory findings, and treatment protocols specific to neonatal care

Exclusion Criteria

Do NOT use P23.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

94640CPT Code

Continuous positive airway pressure (CPAP) ventilation

Clinical Scenario

Used for neonates with respiratory distress due to congenital pneumonia.

Documentation Requirements

Document the need for CPAP based on clinical assessment and response to treatment.

Specialty Considerations

Neonatologists should ensure that the rationale for CPAP use is clearly articulated in the medical record.

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 capture the nuances of neonatal respiratory conditions and their causes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, improving the ability to capture the nuances of neonatal respiratory conditions and their causes.

Reimbursement & Billing Impact

reimbursement.

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 signs of congenital pneumonia in neonates?

Key signs include respiratory distress, tachypnea, grunting, and cyanosis. Early identification and treatment are critical for improving outcomes.