We know about the magical 28 days following the birth of a newborn where those “P codes” rule the roost. The chapter specific guidelines state that ‘these codes take priority in conditions that have their origin in the fetal or perinatal period (before birth through the 28 days after birth) even if morbidity occurs later.’ But what does this mean?
If a neonate is readmitted with jaundice, we know to assign a code from Chapter 16 as the principal diagnosis. But what about a neonate who is discharged at 2 days of life and is readmitted on day 22 with viral meningitis or with COVID-19? Then what do we do?
There are two specific entries in the Official Guidelines for Coding and Reporting that address this issue. The first can be found in the Official Guidelines for Coding and Reporting, Section I.C.16.a.5 and states:
“If a newborn has a condition that may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used. If the condition is community acquired, a code from Chapter 16 should not be assigned.”
EXAMPLE: The neonate is readmitted on day 22 of life with viral meningitis. This is not assigned to Chapter 16. This is not due to the birth process and is therefore community acquired.
The second reference can be found in the Official Guidelines for Coding and Reporting, Section I.C.16.h:
“For a newborn that tests positive for COVID-19, assign code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) in neonates/newborns in the absence of documentation indicating a specific type of transmission. For a newborn that tests positive for COVID-19 and the provider documents the condition was contracted in utero or during the birth process, assign codes P35.8, Other congenital viral diseases, and U07.1, COVID-19. When coding the birth episode in a newborn record, the appropriate code from category Z38, Liveborn infants according to place of birth and type of delivery, should be assigned as the principal diagnosis.”
EXAMPLE: The neonate is readmitted on day 22 of life and presents with cough, fever, and trouble breathing. The neonate tests positive for COVID-19 and notably so does the mother. This is not a birth process and is community acquired; therefore, a Chapter 16 code would not be used. When the documentation does not specify that COVID-19 was contracted in utero or during birth, the P code is not assigned.
Documentation in the medical record will drive the code assignment. Please note that in I.C.16.a.5, the coder is directed to select a code from Chapter 16, defaulting to birth process when documentation does not specify due to the birth process or community acquired.
The default for guideline I.C.16.h, specific to COVID-19, is to assign the condition, U07.1, in the absence of documentation indicating a specific type of transmission.
Alicia R. Blamble, RHIA
Managing Auditor, Excite Health Partners