2025 ICD-10-CM code P25.1
(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
Pneumothorax originating in the perinatal period.
Modifiers may apply depending on the circumstances of the service, such as the place of service or the type of anesthesia provided (if applicable).Consult the appropriate coding guidelines for specific modifier usage.
Medical necessity is established by the presence of a clinically significant pneumothorax requiring intervention to improve respiratory function and prevent complications. Documentation must support the diagnosis and the medical necessity for any interventions provided.
The clinical responsibility involves diagnosing and treating the pneumothorax, determining the underlying cause (if present), and monitoring the newborn's respiratory status.This may involve chest tube placement, respiratory support, and other interventions as clinically indicated.
In simple words: This code describes a collapsed lung in a baby within the first month of life. This is a respiratory problem that started before birth or during the first few weeks after birth.
This ICD-10-CM code classifies pneumothorax (collapsed lung) occurring in newborns within the first 28 days of life.It's a respiratory condition with origins in the fetal or perinatal period.The code is exclusively for use in newborn medical records and should not be applied to maternal records.This code excludes congenital malformations, chromosomal abnormalities, endocrine diseases, and other conditions not directly related to perinatal respiratory issues.
Example 1: A newborn infant presents with respiratory distress shortly after birth. A chest x-ray reveals a pneumothorax.Code P25.1 is used to bill for the diagnosis and treatment., During mechanical ventilation, a preterm infant develops a pneumothorax. The code P25.1 is applied in conjunction with codes specifying the ventilation and any related complications., A full-term infant is diagnosed with a spontaneous pneumothorax within the first week of life. Code P25.1 is assigned to the clinical encounter,and additional codes may be used if further investigations are performed to find the cause of the pneumothorax.
Complete medical history, physical examination findings, chest x-ray results, treatment details (e.g., chest tube insertion, medication administration), and the infant's response to therapy.
** This code is highly specific to the neonatal population. Always confirm the patient's age (less than 28 days old) before applying this code.Proper documentation of clinical findings and interventions is crucial for accurate billing and reimbursement.Incorrect coding can lead to claim denials.
- Payment Status: Active
- Specialties:Neonatology, Pediatrics
- Place of Service:Inpatient Hospital, Neonatal Intensive Care Unit (NICU)