Is ICD-10-CM code P96 billable?

No, P96 (Other 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 P96 belong to?

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

P96Not billable, use a more specific code below

Other conditions originating in the perinatal period

In Other disorders originating in the perinatal period (P90-P96), chapter 16: Certain Conditions Originating in the Perinatal Period

10 billable codes under P96: 2 are a CC; 2 map to HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications).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.

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 P96

P96 can't be used on a claim. Pick a billable code below; grey headings group them.

P96 MS-DRGs

As the principal diagnosis, the billable codes under P96 group to MS-DRG 794, 791, 793, or 795 (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 (7 of 10 codes)
DRG 791 Prematurity with Major Problems (2 of 10 codes)
DRG 793 Full Term Neonate with Major Problems (2 of 10 codes)
DRG 795 Normal Newborn (1 of 10 codes)

Other codes that refer to P96

Notes on these codes point to P96.

CH10 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH11 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH12 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH13 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH14 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH18 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH3 Excludes2: certain conditions originating in the perinatal period (P00-P96)
CH6 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH7 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH8 Excludes2: certain conditions originating in the perinatal period (P04-P96)
CH9 Excludes2: certain conditions originating in the perinatal period (P04-P96)
T36-T50 Excludes2: drug reaction and poisoning affecting newborn (P00-P96)
Z87.6 Includes: Conditions classifiable to P00-P96

About the condition

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

Common Infant and Newborn Problems

It is hard when your baby is sick. Common health problems in babies include colds, coughs, fevers, and vomiting. Babies also commonly have skin problems, like diaper rash or cradle cap.

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.