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2025 ICD-10-CM code P28.3

Primary sleep apnea of newborn;a cessation of breathing during sleep in a newborn.

Always use the most specific code available.When reporting P28.3, a fifth digit is required to specify the type of apnea (central, obstructive, mixed, or unspecified).Ensure that the documentation supports the chosen code, and cross-reference with other codes as needed to fully represent the clinical picture.

Modifiers may be applicable depending on the circumstances of the service provided.Consult the appropriate coding guidelines and payer requirements for specific modifier usage.

Medical necessity for coding P28.3 is established when a newborn exhibits clinically significant apnea episodes requiring medical intervention.This may involve respiratory support, continuous monitoring, or treatment for underlying conditions.The severity and frequency of apnea episodes, the potential for life-threatening complications, and the need for specialized care all contribute to demonstrating medical necessity.

The clinical responsibility for this code falls on the neonatologist or pediatrician managing the newborn's care.This involves assessing the infant for apnea, determining the type of apnea, investigating underlying causes, and implementing appropriate treatment strategies.This might include continuous monitoring, cardiorespiratory support, and management of potential underlying conditions.

IMPORTANT:Additional codes may be necessary to specify the type of apnea (central, obstructive, mixed) using the fifth-digit extension (P28.30-P28.39).Consider also coding any underlying conditions contributing to the apnea.

In simple words: This code describes a condition in newborns where their breathing stops for periods of time while they are sleeping.This can happen for different reasons, and more information may be needed to specify the exact type of breathing problem.

P28.3, Primary sleep apnea of newborn, is an ICD-10-CM code classifying a condition where a newborn infant experiences pauses in breathing during sleep. This can be due to various factors affecting respiratory control or airway patency. The code encompasses different types of sleep apnea, including central, obstructive, and mixed, requiring further specification with a fifth character (e.g., P28.30 for unspecified, P28.31 for central, P28.32 for obstructive, P28.33 for mixed).Accurate coding necessitates identifying the specific type of apnea present.

Example 1: A premature infant, born at 28 weeks gestation, demonstrates periods of apnea during sleep, requiring continuous monitoring in the neonatal intensive care unit (NICU). The apnea is determined to be central in nature, necessitating respiratory support., A full-term newborn is noted to have brief episodes of obstructive apnea during sleep, associated with mild upper airway obstruction. Treatment focuses on optimizing positioning and addressing any contributing factors., A newborn experiences mixed apnea (both central and obstructive components) requiring continuous monitoring and potentially respiratory support to maintain oxygen saturation and prevent cardiorespiratory complications.

Thorough documentation should include details such as gestational age, birth weight, Apgar scores, history of respiratory distress, and any pertinent clinical findings.Detailed descriptions of the apnea episodes, including frequency, duration, and response to interventions, are essential.The type of apnea (central, obstructive, mixed) should be clearly documented, along with any associated findings on physical examination, laboratory tests, and imaging studies.Treatment plans, including any respiratory support provided, should be well documented.

** This code is specific to newborns and should not be used for adults or older children.The use of this code implies the condition originated in the perinatal period (before birth through the first 28 days after birth).

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