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v1.0.0
ICD-10 Guide
ICD-10 CodesP23.8

P23.8

Billable

Congenital pneumonia due to other organisms

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

Code Description

ICD-10 P23.8 is a billable code used to indicate a diagnosis of congenital pneumonia due to other organisms.

Key Diagnostic Point:

Congenital pneumonia due to other organisms refers to pneumonia that is present at birth and caused by pathogens other than the more commonly recognized bacteria and viruses. This condition can arise from intrauterine infections, where the fetus is exposed to infectious agents such as fungi, parasites, or atypical bacteria during gestation. The clinical presentation may include respiratory distress, tachypnea, and hypoxia shortly after birth. Diagnosis typically involves a combination of clinical evaluation, imaging studies such as chest X-rays, and laboratory tests including blood cultures and PCR assays to identify the causative organism. Management often requires supportive care in a neonatal intensive care unit (NICU), including oxygen therapy, mechanical ventilation, and targeted antimicrobial therapy based on the identified pathogen. Early recognition and treatment are crucial to improving outcomes in affected neonates.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential causative organisms complicating diagnosis.
  • Need for accurate laboratory results to identify specific pathogens.
  • Differentiation from other neonatal respiratory conditions.
  • Documentation of maternal history and prenatal infections.

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 documentation of respiratory status, diagnostic tests, and treatment plans is essential.

Common Clinical Scenarios

Infants presenting with respiratory distress shortly after birth, requiring NICU admission for further evaluation.

Billing Considerations

Consideration of maternal health and prenatal infections is critical for accurate coding.

Pediatrics

Documentation Requirements

Thorough documentation of follow-up care and any ongoing respiratory issues is necessary.

Common Clinical Scenarios

Pediatric patients with a history of congenital pneumonia requiring ongoing management for respiratory complications.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use P23.8 When
  • Follow the official ICD
  • CM guidelines for coding pneumonia, ensuring specificity in identifying the causative organism and documenting clinical findings accurately

Exclusion Criteria

Do NOT use P23.8 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 is evaluated for respiratory distress and pneumonia.

Documentation Requirements

Documentation of the infant's clinical status, including vital signs and any interventions.

Specialty Considerations

Neonatologists should ensure comprehensive documentation of respiratory assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital pneumonia, enabling better tracking of epidemiological data and improving the quality of care through targeted interventions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital pneumonia, enabling better tracking of epidemiological data and improving the quality of care through targeted interventions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding congenital pneumonia, enabling better tracking of epidemiological data and improving the quality of care through targeted interventions.

Resources

Clinical References

  • •
    CDC Guidelines on Neonatal Pneumonia

Coding & Billing References

  • •
    CDC Guidelines on Neonatal Pneumonia

Frequently Asked Questions

What are the common causes of congenital pneumonia?

Congenital pneumonia can be caused by a variety of organisms, including bacteria (like Group B Streptococcus), viruses (such as cytomegalovirus), fungi (like Candida), and parasites. The specific cause often depends on maternal health and infections during pregnancy.