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v1.0.0
ICD-10 Guide
ICD-10 CodesP36.8

P36.8

Billable

Other bacterial sepsis of newborn

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

Code Description

ICD-10 P36.8 is a billable code used to indicate a diagnosis of other bacterial sepsis of newborn.

Key Diagnostic Point:

Bacterial sepsis in newborns is a serious condition characterized by the presence of bacteria in the bloodstream, leading to systemic infection. This condition can arise from various bacterial pathogens, including Group B Streptococcus (GBS) and Escherichia coli (E. coli), which are common culprits in early-onset sepsis. Newborns are particularly vulnerable due to their immature immune systems, making early detection and treatment crucial. Symptoms may include lethargy, poor feeding, temperature instability, and respiratory distress. Diagnosis typically involves blood cultures and clinical evaluation. Treatment often requires intravenous antibiotics and supportive care in a neonatal intensive care unit (NICU). The management of bacterial sepsis is critical to prevent long-term complications such as neurodevelopmental delays and organ dysfunction. Understanding the nuances of coding for bacterial sepsis, including differentiating between specific pathogens and recognizing the clinical context, is essential for accurate documentation and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between various bacterial pathogens causing sepsis.
  • Understanding the clinical presentation and severity of sepsis in neonates.
  • Navigating the documentation requirements for NICU admissions.
  • Identifying co-morbid conditions that may complicate the diagnosis.

Audit Risk Factors

  • Inadequate documentation of the causative organism.
  • Failure to document clinical signs and symptoms of sepsis.
  • Misclassification of the type of sepsis (early vs. late onset).
  • Lack of supporting evidence for the severity of the condition.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Accurate timing of symptom onset is crucial for coding early vs. late-onset sepsis.

Pediatrics

Documentation Requirements

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

Common Clinical Scenarios

Follow-up visits for infants discharged from the NICU with a history of sepsis.

Billing Considerations

Consideration of long-term outcomes and developmental assessments in follow-up care.

Coding Guidelines

Inclusion Criteria

Use P36.8 When
  • Follow the official ICD
  • CM guidelines for coding sepsis, ensuring specificity in identifying the organism and clinical context
  • Document all relevant clinical findings and treatment interventions to support the diagnosis

Exclusion Criteria

Do NOT use P36.8 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the critically ill infant or child.

Clinical Scenario

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

Documentation Requirements

Detailed documentation of the clinical condition, interventions, and response to treatment.

Specialty Considerations

Neonatologists must ensure that all critical care services are well-documented to support billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding bacterial sepsis, enabling better tracking of outcomes and resource utilization in neonatal care. This specificity aids in quality improvement initiatives and research.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding bacterial sepsis, enabling better tracking of outcomes and resource utilization in neonatal care. This specificity aids in quality improvement initiatives and research.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding bacterial sepsis, enabling better tracking of outcomes and resource utilization in neonatal care. This specificity aids in quality improvement initiatives and research.

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 bacterial sepsis in newborns?

Common causes include Group B Streptococcus, E. coli, and other bacterial pathogens. Early-onset sepsis typically occurs within the first 72 hours of life, often due to maternal transmission, while late-onset sepsis can occur after the first week, often due to environmental factors.