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ICD-10 Guide
ICD-10 CodesP23.9

P23.9

Billable

Congenital pneumonia, unspecified

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

Code Description

ICD-10 P23.9 is a billable code used to indicate a diagnosis of congenital pneumonia, unspecified.

Key Diagnostic Point:

Congenital pneumonia is a type of pneumonia that occurs in newborns due to infection acquired in utero or during the birthing process. It can result from various pathogens, including bacteria, viruses, and fungi. Intrauterine pneumonia may arise from maternal infections, such as chorioamnionitis, which can lead to the aspiration of infected amniotic fluid by the fetus. Neonatal respiratory infections, including congenital pneumonia, can manifest with symptoms such as respiratory distress, tachypnea, and hypoxia shortly after birth. Diagnosis typically involves clinical evaluation, imaging studies like chest X-rays, and laboratory tests to identify the causative organism. Treatment may include antibiotics, respiratory support, and supportive care in a neonatal intensive care unit (NICU). The prognosis depends on the severity of the infection and the timeliness of intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between congenital pneumonia and other respiratory conditions
  • Identifying the specific pathogen responsible for pneumonia
  • Documenting maternal health history and potential risk factors
  • Understanding the timing of infection (in utero vs. postnatal)

Audit Risk Factors

  • Inadequate documentation of maternal infections
  • Failure to specify the timing of pneumonia onset
  • Misclassification of pneumonia type
  • Lack of clarity in clinical notes regarding respiratory symptoms

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on respiratory assessment, maternal history, and treatment plans.

Common Clinical Scenarios

Infants presenting with respiratory distress in the NICU, requiring immediate evaluation and management.

Billing Considerations

Accurate coding requires thorough documentation of clinical findings and treatment responses.

Pediatrics

Documentation Requirements

Comprehensive records of patient history, including prenatal exposures and postnatal assessments.

Common Clinical Scenarios

Pediatric follow-up visits for infants with a history of congenital pneumonia.

Billing Considerations

Consideration of long-term outcomes and potential complications in pediatric care.

Coding Guidelines

Inclusion Criteria

Use P23.9 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that documentation supports the diagnosis of congenital pneumonia and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use P23.9 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 requires initial evaluation in the NICU.

Documentation Requirements

Documentation must include a thorough assessment of respiratory status and any interventions performed.

Specialty Considerations

Neonatologists should ensure that all relevant clinical findings are documented to support the coding.

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 underlying 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 underlying causes.

Reimbursement & Billing Impact

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 underlying causes.

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 common causes of congenital pneumonia?

Common causes of congenital pneumonia include maternal infections such as chorioamnionitis, Group B Streptococcus, and viral infections like cytomegalovirus. Accurate coding requires understanding the maternal history and potential risk factors.