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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.0

P36.0

Billable

Sepsis of newborn due to streptococcus, group B

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

Code Description

ICD-10 P36.0 is a billable code used to indicate a diagnosis of sepsis of newborn due to streptococcus, group b.

Key Diagnostic Point:

Group B Streptococcus (GBS) is a common bacterium found in the intestines and lower genital tract of healthy adults. However, in newborns, particularly those who are premature or have low birth weight, GBS can lead to severe infections, including sepsis. Sepsis in newborns is a life-threatening condition characterized by systemic inflammation and can result from bacterial infections, with GBS being a significant pathogen. Clinical manifestations may include respiratory distress, temperature instability, lethargy, and feeding intolerance. Diagnosis is typically made through blood cultures, and treatment involves prompt initiation of intravenous antibiotics. The timing of GBS exposure during labor and delivery is critical, as early-onset sepsis occurs within the first week of life, while late-onset sepsis can occur after the first week. Understanding the risk factors, such as maternal GBS colonization and prolonged rupture of membranes, is essential for effective management and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between early-onset and late-onset sepsis.
  • Understanding maternal risk factors and their documentation.
  • Interpreting laboratory results and their implications for coding.
  • Navigating the nuances of co-infections with other pathogens.

Audit Risk Factors

  • Inadequate documentation of maternal GBS status.
  • Failure to document the onset of symptoms accurately.
  • Misclassification of early-onset versus late-onset sepsis.
  • Inconsistent coding of associated conditions or complications.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes on the newborn's condition, including vital signs, lab results, and treatment plans.

Common Clinical Scenarios

Newborn presenting with respiratory distress and lethargy shortly after birth, requiring NICU admission.

Billing Considerations

Accurate timing of symptom onset and maternal history are crucial for coding.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination notes, including follow-up care and developmental assessments.

Common Clinical Scenarios

Infants with late-onset sepsis presenting with fever and irritability in a pediatric ward.

Billing Considerations

Consideration of the infant's growth and development post-sepsis treatment.

Coding Guidelines

Inclusion Criteria

Use P36.0 When
  • Follow the ICD
  • CM guidelines for coding infections, ensuring that the documentation supports the diagnosis of sepsis and its causative organism
  • Specific criteria for neonatal sepsis must be met, including clinical signs and laboratory confirmation

Exclusion Criteria

Do NOT use P36.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill infant

Clinical Scenario

Used when a newborn with GBS sepsis requires intensive monitoring and management.

Documentation Requirements

Detailed notes on the infant's clinical status, interventions, and response to treatment.

Specialty Considerations

Neonatologists must document the severity of illness and complexity of care provided.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neonatal conditions, including GBS sepsis, improving data accuracy and facilitating better tracking of outcomes and epidemiology.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neonatal conditions, including GBS sepsis, improving data accuracy and facilitating better tracking of outcomes and epidemiology.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neonatal conditions, including GBS sepsis, improving data accuracy and facilitating better tracking of outcomes and epidemiology.

Resources

Clinical References

  • •
    CDC Group B Streptococcus Information

Coding & Billing References

  • •
    CDC Group B Streptococcus Information

Frequently Asked Questions

What are the common symptoms of GBS sepsis in newborns?

Common symptoms include respiratory distress, lethargy, feeding intolerance, and temperature instability. Early recognition is crucial for effective treatment.