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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.1

P36.1

Billable

Sepsis of newborn due to other and unspecified streptococci

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

Code Description

ICD-10 P36.1 is a billable code used to indicate a diagnosis of sepsis of newborn due to other and unspecified streptococci.

Key Diagnostic Point:

Sepsis in newborns is a severe systemic infection that can lead to significant morbidity and mortality. This condition is often caused by various bacteria, including group B streptococcus (GBS) and other streptococci, as well as Escherichia coli (E. coli). Newborns are particularly vulnerable due to their immature immune systems, making early identification and treatment critical. Symptoms of sepsis may include lethargy, poor feeding, temperature instability, respiratory distress, and hypotonia. Diagnosis typically involves blood cultures, clinical evaluation, and sometimes imaging studies. Treatment usually consists of broad-spectrum intravenous antibiotics, and in some cases, supportive care in a neonatal intensive care unit (NICU). The management of sepsis requires a multidisciplinary approach, including neonatologists, nurses, and pharmacists, to ensure timely intervention and monitoring of the newborn's response to therapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various bacterial causes of sepsis.
  • Understanding the clinical presentation of sepsis in neonates.
  • Navigating the nuances of coding for unspecified streptococci.
  • Recognizing the overlap with other perinatal infections.

Audit Risk Factors

  • Inadequate documentation of clinical symptoms and laboratory findings.
  • Failure to specify the causative organism when known.
  • Misclassification of sepsis severity.
  • Inconsistent coding practices across different healthcare settings.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed clinical notes including vital signs, laboratory results, and treatment plans.

Common Clinical Scenarios

Newborn presenting with lethargy and poor feeding, requiring sepsis workup in NICU.

Billing Considerations

Accurate coding requires thorough documentation of the clinical course and response to treatment.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination, including maternal history and delivery details.

Common Clinical Scenarios

Pediatric follow-up for a newborn discharged after treatment for sepsis.

Billing Considerations

Consideration of long-term outcomes and potential complications from sepsis.

Coding Guidelines

Inclusion Criteria

Use P36.1 When
  • Follow the ICD
  • CM guidelines for coding infections, ensuring specificity in the documentation of the causative organism and clinical presentation
  • Use additional codes as necessary to capture complications or associated conditions

Exclusion Criteria

Do NOT use P36.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill newborn

Clinical Scenario

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

Documentation Requirements

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

Specialty Considerations

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. It emphasizes the importance of accurate documentation to support the chosen codes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. It emphasizes the importance of accurate documentation to support the chosen codes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of neonatal sepsis, improving the ability to track and manage these conditions. It emphasizes the importance of accurate documentation to support the chosen codes.

Resources

Clinical References

  • •
    CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Coding & Billing References

  • •
    CDC Guidelines for the Prevention of Perinatal Group B Streptococcal Disease

Frequently Asked Questions

What are the common causes of sepsis in newborns?

Common causes include group B streptococcus, E. coli, and other bacterial infections. Early identification and treatment are crucial for improving outcomes.