2025 ICD-10-CM code P23.0
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory - Respiratory and cardiovascular disorders specific to the perinatal period (P19-P29) Certain conditions originating in the perinatal period (P00-P96) Feed
Congenital pneumonia due to a viral agent.Use additional code (B97) to specify the organism.
Medical necessity for this code is established by the presence of clinical findings (respiratory distress, cough, fever, etc.) suggestive of pneumonia in a newborn. Confirmation of the viral etiology through laboratory testing strengthens the medical necessity.Treatment is necessary to manage respiratory compromise and prevent potential complications.
Diagnosis and treatment of neonatal respiratory distress;management of the infection;monitoring respiratory function and vital signs;administration of oxygen therapy or other respiratory support as needed;antibiotic therapy if bacterial infection is suspected or confirmed.
In simple words: This code is for babies born with pneumonia caused by a virus.The doctor will also use another code to identify the exact virus.
This ICD-10-CM code classifies congenital pneumonia caused by a viral agent in newborns.It is used to record pneumonia originating in the fetal or perinatal period (before birth through the first 28 days after birth).An additional code from category B97 should be used to identify the specific infectious organism involved.This code is exclusively for newborn records and should never be used on maternal records.This code excludes congenital rubella pneumonitis (P35.0).
Example 1: A newborn presents with respiratory distress, tachypnea, and cyanosis shortly after birth.Chest X-ray reveals a diffuse interstitial pattern consistent with viral pneumonia.Laboratory results confirm a viral infection. P23.0 is assigned., A premature infant is diagnosed with congenital pneumonia after exhibiting symptoms such as cough, fever, and lethargy during the first week of life.Further testing identifies respiratory syncytial virus (RSV).Codes P23.0 and B97.2 (Respiratory syncytial virus) are assigned., A newborn presents with signs of respiratory infection.Testing results are inconclusive and the type of organism cannot be determined definitively.Code P23.9 (Congenital pneumonia, unspecified) is assigned pending further investigation.
Maternal history (including infections during pregnancy), detailed neonatal history (including symptoms, gestational age, birth weight, and mode of delivery), physical examination findings, chest X-ray results, laboratory results (e.g., complete blood count, blood cultures, viral studies), respiratory support measures employed, and response to treatment.
** Always ensure proper documentation to support the diagnosis and justify medical necessity.In the absence of definitive diagnostic testing, use the unspecified code (P23.9) and document the reason for the uncertainty.
- Payment Status: Active
- Specialties:Neonatology, Pediatrics, Infectious Disease
- Place of Service:Inpatient Hospital, Birthing Center