Is ICD-10-CM code P23 billable?

No, P23 (Congenital pneumonia) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code P23 belong to?

P23 belongs to Chapter 16 of the ICD-10-CM tabular list: P00–P96 (Certain Conditions Originating in the Perinatal Period).

P23Not billable, use a more specific code below

Congenital pneumonia

In Respiratory and cardiovascular disorders specific to the perinatal period (P19-P29), chapter 16: Certain Conditions Originating in the Perinatal Period

9 billable codes under P23: all are an MCC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Includes: conditions that are coded here

infective pneumonia acquired in utero or during birth

Excludes1: not coded here, use a different code

neonatal pneumonia resulting from aspiration (P24.-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Coding of conditions that originate from before birth through the 28th day after birth, including newborn record rules, prematurity, low birth weight, sepsis, and stillbirth.

General Perinatal Rules (page 71)
Observation and Evaluation of Newborns for Suspected Conditions not Found (page 73)
Coding Additional Perinatal Diagnoses (page 73)
Prematurity and Fetal Growth Retardation (page 73)
Low birth weight and immaturity status (page 74)
Bacterial Sepsis of Newborn (page 74)
Stillbirth (page 74)
COVID-19 Infection in Newborn (page 74)

Read Section I.C.16 (page 71)

All codes under P23

P23 can't be used on a claim. Pick a billable code below; grey headings group them.

P23 MS-DRGs

As the principal diagnosis, all 9 billable codes under P23 group to MS-DRG 791 or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

Other codes that refer to P23

Notes on these codes point to P23.

J15 Excludes1: congenital pneumonia (P23.-)
J16 Excludes1: congenital pneumonia (P23.-)
P35-P39 Excludes2: congenital pneumonia (P23.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Pneumonia

Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.

Uncommon Infant and Newborn Problems

It can be scary when your baby is sick, especially when it is not an everyday problem like a cold or a fever. You may not know whether the problem is serious or how to treat it. If you have concerns about your baby's health, call your health care provider right away.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.