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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.30

P36.30

Billable

Sepsis of newborn due to unspecified staphylococci

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

Code Description

ICD-10 P36.30 is a billable code used to indicate a diagnosis of sepsis of newborn due to unspecified staphylococci.

Key Diagnostic Point:

Sepsis in newborns is a severe and potentially life-threatening condition characterized by the presence of bacteria in the bloodstream. In cases of sepsis due to unspecified staphylococci, the causative agent is not clearly identified, which complicates treatment and management. Newborns are particularly vulnerable due to their immature immune systems, making them susceptible to infections from various bacteria, including group B streptococcus and E. coli. Symptoms of sepsis may include lethargy, poor feeding, temperature instability, and respiratory distress. Early recognition and prompt treatment with antibiotics are critical to improving outcomes. The management of sepsis in neonates often requires admission to a Neonatal Intensive Care Unit (NICU) for close monitoring and supportive care. The coding of this condition requires careful documentation of clinical findings, laboratory results, and treatment protocols to ensure accurate representation of the patient's condition and the complexity of care provided.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of sepsis in newborns
  • Need for precise documentation of symptoms and laboratory findings
  • Differentiation between various bacterial pathogens
  • Potential for co-infections with other pathogens

Audit Risk Factors

  • Inadequate documentation of clinical symptoms
  • Failure to specify the causative organism when known
  • Misclassification of sepsis severity
  • Inconsistent coding of co-existing conditions

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Consideration of gestational age and birth weight, as these factors influence the risk of sepsis.

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

Monitoring for long-term effects of sepsis and potential developmental delays.

Coding Guidelines

Inclusion Criteria

Use P36.30 When
  • Follow the official ICD
  • CM coding guidelines for sepsis, ensuring that all relevant clinical information is documented
  • Use additional codes to specify the organism when known and to capture any associated conditions

Exclusion Criteria

Do NOT use P36.30 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 sepsis in the NICU.

Documentation Requirements

Document the clinical findings and rationale for sepsis evaluation.

Specialty Considerations

Neonatologists should ensure comprehensive documentation of the infant's condition.

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 cases effectively. It emphasizes the importance of accurate documentation to reflect the complexity of neonatal care.

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 cases effectively. It emphasizes the importance of accurate documentation to reflect the complexity of neonatal care.

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 cases effectively. It emphasizes the importance of accurate documentation to reflect the complexity of neonatal care.

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.