ICD-10 Guide

P36

Non-billable

Bacterial sepsis of newborn

Chapter 16:Certain conditions originating in the perinatal period

BILLABLE STATUSNo

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/05/2025

Code Description

ICD-10 P36 is a used to indicate a diagnosis of bacterial sepsis of newborn.

Key Diagnostic Point:

Bacterial sepsis of newborn (ICD-10 code P36) refers to a severe systemic infection in neonates caused by bacteria. This condition can manifest shortly after birth and is characterized by the presence of bacteria in the bloodstream, leading to a systemic inflammatory response. Common pathogens include Group B Streptococcus and Escherichia coli, which can be transmitted from the mother during labor or through environmental exposure. Early diagnosis and treatment are critical, as bacterial sepsis can lead to significant morbidity and mortality in newborns. The clinical presentation may include temperature instability, lethargy, feeding intolerance, and respiratory distress, necessitating prompt medical intervention.

The clinical significance of P36 lies in its implications for neonatal care and the need for vigilant monitoring of at-risk infants. The coding of bacterial sepsis in newborns is essential for tracking incidence rates, guiding treatment protocols, and ensuring appropriate resource allocation in neonatal intensive care units (NICUs). Usage guidelines recommend that healthcare providers utilize this code when diagnosing and treating newborns with confirmed or suspected bacterial sepsis, ensuring that all relevant clinical findings and laboratory results are documented to support the diagnosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Variability in clinical presentation
Need for rapid diagnostic testing
Differential diagnosis considerations

Audit Risk Factors

Inadequate documentation of clinical findings
Misdiagnosis of sepsis versus other conditions
Failure to update codes based on laboratory results

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Neonatology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

From an administrative perspective, the P36 code category plays a critical role in healthcare trends, particularly in the context of neonatal intensive care. As healthcare systems increasingly focus on data-driven decision-making, the accurate coding of conditions like bacterial sepsis ensures that resources are allocated effectively and that quality improvement initiatives are based on reliable data. This, in turn, can lead to better health outcomes for vulnerable populations, such as newborns at risk for sepsis.

ICD-9 vs ICD-10

The clinical impact of the P36 code category is significant, as it directly relates to the management of bacterial sepsis in newborns, a condition that can lead to severe complications and long-term health issues if not treated promptly. Accurate coding and documentation of P36 can enhance quality measures in neonatal care, allowing healthcare providers to track outcomes and improve treatment protocols. Furthermore, understanding the epidemiology of bacterial sepsis can inform public health initiatives aimed at reducing incidence rates and improving maternal and neonatal health outcomes. From an administrative perspective, the P36 code category plays a critical role in healthcare trends, particularly in the context of neonatal intensive care. As healthcare systems increasingly focus on data-driven decision-making, the accurate coding of conditions like bacterial sepsis ensures that resources are allocated effectively and that quality improvement initiatives are based on reliable data. This, in turn, can lead to better health outcomes for...

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the level of care provided. It is crucial to use appropriate CPT codes in conjunction with P36 to reflect the services rendered accurately. Common CPT codes related to this category include critical care codes (99291, 99292) and laboratory tests (36415) for blood cultures.

Resources

Clinical References

•
Official ICD-10 Guidelines for P36

Coding & Billing References

•
Official ICD-10 Guidelines for P36

Frequently Asked Questions

What conditions are included in P36?

P36 includes various forms of bacterial sepsis in newborns, primarily those caused by common pathogens such as Group B Streptococcus and Escherichia coli. It covers both early-onset sepsis, which occurs within the first 72 hours of life, and late-onset sepsis, which can occur after this period.

When should I use P36 codes?

P36 codes should be used when a newborn is diagnosed with bacterial sepsis, either confirmed through laboratory testing or suspected based on clinical presentation. It is important to document all relevant clinical signs and laboratory results to support the use of this code.

What documentation is required for P36?

Documentation for P36 should include a clear clinical assessment of the newborn, laboratory results confirming the presence of bacteria in the bloodstream, and any treatment provided. Additionally, details regarding the onset of symptoms and any risk factors should be included to substantiate the diagnosis.

ICD-10 P36 is a used to indicate a diagnosis of bacterial sepsis of newborn.

Key Diagnostic Point:

The clinical significance of P36 lies in its implications for neonatal care and the need for vigilant monitoring of at-risk infants. The coding of bacterial sepsis in newborns is essential for tracking incidence rates, guiding treatment protocols, and ensuring appropriate resource allocation in neonatal intensive care units (NICUs). Usage guidelines recommend that healthcare providers utilize this code when diagnosing and treating newborns with confirmed or suspected bacterial sepsis, ensuring that all relevant clinical findings and laboratory results are documented to support the diagnosis.