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v1.0.0
ICD-10 Guide
ICD-10 CodesP23.6

P23.6

Billable

Congenital pneumonia due to other bacterial agents

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

Code Description

ICD-10 P23.6 is a billable code used to indicate a diagnosis of congenital pneumonia due to other bacterial agents.

Key Diagnostic Point:

Congenital pneumonia due to other bacterial agents is a serious condition that occurs when a newborn is infected with bacteria in utero, leading to pneumonia at birth. This condition can arise from various bacterial pathogens that are not classified under more common categories, such as Group B Streptococcus or Escherichia coli. The infection may occur due to maternal factors, including chorioamnionitis, prolonged rupture of membranes, or maternal infections. Symptoms in the neonate may include respiratory distress, tachypnea, grunting, and cyanosis. Diagnosis is typically confirmed through clinical evaluation, chest X-rays, and laboratory tests, including blood cultures. Early recognition and treatment are crucial to improve outcomes, as untreated congenital pneumonia can lead to significant morbidity and mortality in neonates. Management often involves the use of broad-spectrum antibiotics and supportive care in a neonatal intensive care unit (NICU).

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of bacterial agents that can cause the condition, complicating diagnosis.
  • Need for thorough maternal history to identify potential risk factors.
  • Differentiation from other neonatal respiratory conditions.
  • Potential for co-infections that may require additional coding.

Audit Risk Factors

  • Inadequate documentation of maternal health history.
  • Failure to specify the bacterial agent responsible for pneumonia.
  • Misclassification of pneumonia type (congenital vs. acquired).
  • Lack of supporting diagnostic tests in the medical record.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed documentation of respiratory status, maternal history, and diagnostic tests performed.

Common Clinical Scenarios

Neonates presenting with respiratory distress shortly after birth, requiring NICU admission for management.

Billing Considerations

Accurate coding requires clear differentiation between congenital and acquired pneumonia.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including follow-up evaluations for respiratory function.

Common Clinical Scenarios

Pediatric patients with a history of congenital pneumonia presenting with ongoing respiratory issues.

Billing Considerations

Consideration of long-term outcomes and potential complications from congenital pneumonia.

Coding Guidelines

Inclusion Criteria

Use P23.6 When
  • Coders should refer to the official ICD
  • CM coding guidelines, ensuring that all documentation supports the diagnosis of congenital pneumonia due to other bacterial agents
  • Specific criteria include the need for clinical evidence of pneumonia and identification of the causative organism when possible

Exclusion Criteria

Do NOT use P23.6 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 infant

Clinical Scenario

Used when a newborn with congenital pneumonia is admitted for evaluation.

Documentation Requirements

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

Specialty Considerations

Neonatologists should ensure that all aspects of care are documented to support the complexity of the case.

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, enabling better tracking of cases and outcomes. The granularity of ICD-10 codes helps in understanding the epidemiology of congenital pneumonia and improving clinical management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, enabling better tracking of cases and outcomes. The granularity of ICD-10 codes helps in understanding the epidemiology of congenital pneumonia and improving clinical management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital pneumonia, enabling better tracking of cases and outcomes. The granularity of ICD-10 codes helps in understanding the epidemiology of congenital pneumonia and improving clinical management.

Resources

Clinical References

  • •
    CDC Guidelines for Neonatal Pneumonia

Coding & Billing References

  • •
    CDC Guidelines for Neonatal Pneumonia

Frequently Asked Questions

What are the common bacterial agents causing congenital pneumonia?

Common bacterial agents include Group B Streptococcus, Escherichia coli, and other less common organisms. Identifying the specific agent is crucial for appropriate treatment.

How can congenital pneumonia be differentiated from other neonatal respiratory conditions?

Congenital pneumonia is typically diagnosed based on maternal history, clinical presentation at birth, and specific diagnostic tests that confirm the presence of infection acquired in utero.