Is ICD-10-CM code P55 billable?

No, P55 (Hemolytic disease of newborn) 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 P55 belong to?

P55 belongs to Chapter 16 of the ICD-10-CM tabular list: P00–P96 (Certain Conditions Originating in the Perinatal Period).

P55Not billable, use a more specific code below

Hemolytic disease of newborn

In Hemorrhagic and hematological disorders of newborn (P50-P61), chapter 16: Certain Conditions Originating in the Perinatal Period

4 billable codes under P55: none are a CC or MCC; all map to HCC 109 (Acquired Hemolytic, Aplastic, and Sideroblastic Anemias).An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Also applies, from Hemorrhagic and hematological disorders of newborn (P50-P61)

These notes sit on P50-P61 and apply to every code under it, including P55.

Excludes1: not coded here, use a different code

congenital stenosis and stricture of bile ducts (Q44.3)
Crigler-Najjar syndrome (E80.5)
Dubin-Johnson syndrome (E80.6)
Gilbert syndrome (E80.4)
hereditary hemolytic anemias (D55-D58)

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 P55

P55 can't be used on a claim. Pick a billable code below; grey headings group them.

P55 MS-DRGs

As the principal diagnosis, the billable codes under P55 group to MS-DRG 791, 793, or 794 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 791 Prematurity with Major Problems (2 of 4 codes)
DRG 793 Full Term Neonate with Major Problems (2 of 4 codes)
DRG 794 Neonate with Other Significant Problems (2 of 4 codes)

Other codes that refer to P55

Notes on these codes point to P55.

D58 Excludes1: hemolytic anemia of the newborn (P55.-)
D59.1 Excludes2: hemolytic disease of newborn (P55.-)
K72 Excludes1: icterus of newborn (P55-P59)
K76.82 Code Also: icterus of newborn (P55-P59)
P58 Excludes1: jaundice due to isoimmunization (P55-P57)
R17 Excludes1: neonatal jaundice (P55, P57-P59)
R71 Excludes1: newborn anemia due to isoimmunization (P55.-)
R76.0 Excludes1: isoimmunization affecting newborn (P55.-)

About the condition

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

Blood Disorders

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

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.