2025 ICD-10-CM code P28.4
(Active) Effective Date: N/A Revision Date: N/A Perinatal Conditions - Respiratory and cardiovascular disorders specific to the perinatal period Certain conditions originating in the perinatal period (P00-P96) Feed
Other apnea of newborn; this code is for use on newborn records only.
No modifiers are applicable to ICD-10 codes.
The medical necessity of codes is based on the clinical presentation of the patient.Documentation must support that the apnea is clinically significant and requires medical attention. This may involve risk factors for apnea such as prematurity or underlying health conditions.
The clinical responsibility for diagnosing and managing neonatal apnea rests primarily with the neonatologist or pediatrician.Depending on the severity and complexity of the case, other specialists, such as a cardiologist or neurologist, may also be involved.
- Certain conditions originating in the perinatal period (P00-P96)
- P28.4 falls under the broader category of respiratory and cardiovascular disorders specific to the perinatal period (P28).
In simple words: This code describes breathing pauses in a newborn baby that aren't caused by the reasons listed in other similar codes. It is only used for babies up to 28 days old.If the baby stops breathing, the doctor should look for and document any additional symptoms and any underlying problems.
Other apnea of newborn.This ICD-10-CM code classifies apnea in newborns that doesn't fit into other specified apnea categories.It's crucial to remember that this code is exclusively for newborn records (up to 28 days of life) and should never be used for maternal records.The diagnosis should be supported by clinical findings such as periods of absent breathing, bradycardia, and/or cyanosis.Consider the possibility of underlying conditions and document accordingly.
Example 1: A full-term newborn presents with episodes of apnea lasting 15-20 seconds, associated with bradycardia and mild cyanosis.No underlying condition is identified after comprehensive evaluation.P28.4 is coded., A preterm infant displays central apnea, requiring continuous monitoring and intermittent positive pressure ventilation. No specific cause of apnea is identified after investigations, so P28.4 is used., A term newborn experiences apnea associated with seizures, and after appropriate testing, it is determined that the apnea is not caused by the identified neurological issues. P28.4 is used in addition to the codes that describe the seizures.
Detailed documentation is required to support the diagnosis of P28.4. This should include the frequency, duration, and severity of apneic episodes, presence of bradycardia or cyanosis, any associated symptoms (e.g., irritability, poor feeding), results of any diagnostic testing (e.g., blood gas analysis, EKG), and treatment provided.
** This code is often used in conjunction with codes describing the treatment rendered for apnea.Accurate documentation supporting the diagnosis is key for appropriate reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Specialties:Neonatology, Pediatrics
- Place of Service:Inpatient Hospital, Neonatal Intensive Care Unit (NICU)