Is ICD-10-CM code P28 billable?

No, P28 (Other respiratory conditions originating in the perinatal period) 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 P28 belong to?

P28 belongs to Chapter 16 of the ICD-10-CM tabular list: P00–P96 (Certain Conditions Originating in the Perinatal Period).

P28Not billable, use a more specific code below

Other respiratory conditions originating in the perinatal period

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

19 billable codes under P28: 2 are an MCC, 15 are a CC; 6 map to HCC 213 (Cardio-Respiratory Failure and Shock), HCC 212 (Respiratory Arrest).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Code also: add a code for this too, order depends on the encounter

if applicable, congenital malformations of the respiratory system (Q30-Q34)

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 P28

P28 can't be used on a claim. Pick a billable code below; grey headings group them.

P28 MS-DRGs

As the principal diagnosis, the billable codes under P28 group to MS-DRG 794, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 794 Neonate with Other Significant Problems (17 of 19 codes)
DRG 791 Prematurity with Major Problems (2 of 19 codes)
DRG 793 Full Term Neonate with Major Problems (2 of 19 codes)

About the condition

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

Lung Diseases

When you breathe, your lungs take in oxygen from the air and deliver it to the bloodstream. The cells in your body need oxygen to work and grow. During a normal day, you breathe nearly 25,000 times. People with lung disease have difficulty breathing. Millions of people in the U.S. have lung disease. If all types of lung disease are lumped together, it is the number three killer in the United States.

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.