Chapter 16 — Certain Conditions Originating in the Perinatal Period
The newborn record: Z38 once and only once, the six clinical-significance criteria, prematurity and birth weight, and the congenital-sepsis default.
The perinatal period is before birth through the 28th day following birth — but Chapter 16 codes may be used throughout the life of the patient if the condition is still present. The two absolute rules are the mirror image of each other: no Chapter 16 code on the maternal record, and no Chapter 15 code on the newborn record.
General perinatal rules#
| # | Rule | Detail |
|---|---|---|
| 1 | Use of Chapter 16 codes | NEVER Codes in this chapter are never for use on the maternal record. NEVER Codes from Chapter 15 are never permitted on the newborn record. Chapter 16 codes may be used throughout the life of the patient if the condition is still present |
| 2 | Principal diagnosis for the birth record | A code from category Z38 liveborn infants according to place of birth and type of delivery is the principal diagnosis. Assigned only once, at the time of birth. NEVER If a newborn is transferred to another institution, Z38 is not used at the receiving hospital. Z38 is used only on the newborn record, never on the mother's |
| 3 | Codes from other chapters | May be used with Chapter 16 codes where they provide more specific detail. Signs and symptom codes may be assigned where a definitive diagnosis has not been established. Where the reason for the encounter is a perinatal condition, the Chapter 16 code is sequenced first |
| 4 | After the perinatal period | Where a condition originates in the perinatal period and continues throughout the life of the patient, the perinatal code continues to be used regardless of the patient's age |
| 5 | Birth process or community acquired | Where a newborn has a condition that may be either due to the birth process or community acquired and the documentation does not indicate which, the default is due to the birth process and the Chapter 16 code is used. If the condition is community-acquired, a Chapter 16 code is not assigned |
| 6 | Code all clinically significant conditions | All clinically significant conditions noted on routine newborn examination are coded. See the criteria below |
| A newborn condition is clinically significant if it requires | Present in Section III? |
|---|---|
| Clinical evaluation | Yes |
| Therapeutic treatment | Yes |
| Diagnostic procedures | Yes |
| Extended length of hospital stay | Yes |
| Increased nursing care and/or monitoring | Yes |
| Has implications for future health care needs | EXCEPTION No — this sixth criterion is unique to the perinatal guidelines |
Observation of newborns — category Z05#
| Situation | Rule |
|---|---|
When Z05 applies | A healthy newborn is evaluated for a suspected condition or disease that is determined after study not to be present |
| When it does not | NEVER Do not use Z05 where the patient is documented to have signs or symptoms of a suspected problem — code the sign or symptom instead |
| On the birth record | Z05 is a secondary code, assigned after the code from category Z38 |
| On other than the birth record | Z05 may be the principal or first-listed code for readmissions or encounters where Z38 no longer applies. Codes from Z05 are for use only for healthy newborns and infants for which no condition is found to be present after study |
Prematurity, birth weight and newborn sepsis#
| Topic | Rule |
|---|---|
| Prematurity | Providers use different criteria in determining prematurity. NEVER A code for prematurity is not assigned unless it is documented |
Categories P05 and P07 | Assignment is based on the recorded birth weight and estimated gestational age |
| Both birth weight and gestational age available | ALWAYS Two codes from category P07, with the code for birth weight sequenced before the code for gestational age |
| Low birth weight and immaturity status | Category P07 codes are for use for a child or adult who was premature or had a low birth weight as a newborn where this is affecting the patient's current health status |
Bacterial sepsis of newborn — category P36 | Includes congenital sepsis. Where a perinate is documented as having sepsis without documentation of congenital or community acquired, the default is congenital and a code from P36 is assigned |
Organism codes with P36 | If the P36 code includes the causal organism, NEVER do not assign an additional code from B95 or B96. If the P36 code does not include the organism, assign an additional code from B96. Use additional codes for severe sepsis R65.2- and any associated acute organ dysfunction if applicable |
Stillbirth — P95 | For use only in institutions that maintain separate records for stillbirths. NEVER No other code is used with P95, and P95 is never used on the mother's record |
| COVID-19 in a newborn | Positive test with no documentation of a specific type of transmission → U07.1 plus codes for associated manifestations in neonates. Provider documents the condition was contracted in utero or during the birth process → P35.8 and U07.1. On the birth episode, Z38 remains the principal diagnosis |
Practice questions#
Q1A newborn delivered at Hospital A is transferred to Hospital B's neonatal intensive care unit on day one. What does Hospital B assign as the principal diagnosis?
- AA code from category
Z38 - BThe perinatal condition that occasioned the transfer
- C
Z05.- - DA code from Chapter 15
Show answer & rationale
Correct answer: B. The perinatal condition that occasioned the transfer
Rationale. Guideline I.C.16.a.2 states that a code from category Z38 is assigned only once, to a newborn at the time of birth, and that if a newborn is transferred to another institution a code from category Z38 should not be used at the receiving hospital. Guideline I.C.16.a.3 then directs that where the reason for the encounter is a perinatal condition, the code from chapter 16 should be sequenced first.
Q2A newborn's record documents sepsis with no statement of whether it is congenital or community acquired. What is assigned?
- AA code from
A41withB96 - BA code from category
P36 - C
R65.20alone - DNo code until the provider clarifies
Show answer & rationale
Correct answer: B. A code from category P36
Rationale. Guideline I.C.16.f states that category P36 bacterial sepsis of newborn includes congenital sepsis, and that if a perinate is documented as having sepsis without documentation of congenital or community acquired, the default is congenital and a code from category P36 should be assigned. If the P36 code includes the causal organism, no additional B95 or B96 code is assigned; if it does not, an additional code from B96 is added.
Q3A newborn's record documents both a birth weight of 1,450 grams and an estimated gestational age of 31 weeks. What is assigned?
- AOne code for birth weight
- BOne code for gestational age
- CTwo codes from
P07, birth weight sequenced before gestational age - DTwo codes from
P07, gestational age sequenced first
Show answer & rationale
Correct answer: C. Two codes from P07, birth weight sequenced before gestational age
Rationale. Guideline I.C.16.d states that when both birth weight and gestational age are available, two codes from category P07 should be assigned, with the code for birth weight sequenced before the code for gestational age. The same guideline notes that a code for prematurity should not be assigned unless it is documented, because providers use different criteria in determining prematurity.
Q4A healthy newborn is evaluated on the birth admission for suspected sepsis, which is ruled out after study. No signs or symptoms were documented. What is assigned?
- A
Z05.1-as the principal diagnosis - BA code from
Z38as principal, withZ05.1-as a secondary code - CA code from
P36 - D
Z05.1-only
Show answer & rationale
Correct answer: B. A code from Z38 as principal, with Z05.1- as a secondary code
Rationale. Guideline I.C.16.b.3 states that a code from category Z05 is to be used as a secondary code after the code from category Z38 on a birth record. Guideline I.C.16.b.1 permits Z05 only where a healthy newborn is evaluated for a suspected condition determined after study not to be present, and prohibits it where the patient is documented to have signs or symptoms — in which case the sign or symptom is coded.
Q5A newborn has a condition that could be due to the birth process or could be community acquired, and the documentation does not say which. What is the default?
- ACommunity acquired; do not use a Chapter 16 code
- BDue to the birth process; use the Chapter 16 code
- CQuery the provider before coding anything
- DAssign both a Chapter 16 code and a community-acquired code
Show answer & rationale
Correct answer: B. Due to the birth process; use the Chapter 16 code
Rationale. Guideline I.C.16.a.5 states that if a newborn has a condition that may be either due to the birth process or community acquired and the documentation does not indicate which it is, the default is due to the birth process and the code from Chapter 16 should be used. If the condition is documented as community-acquired, a code from Chapter 16 should not be assigned.
Scenarios#
A single liveborn infant is delivered vaginally in hospital. On routine examination the newborn is noted to have physiological jaundice requiring phototherapy and an extended stay of 24 hours.
Show coded answer & rationale
| Seq | Code | Description |
|---|---|---|
| 1 | Z38.00 | Single liveborn infant, delivered vaginally — principal diagnosis |
| 2 | P59.9 | Neonatal jaundice, unspecified — or the specific code the record supports |
Rationale. Guideline I.C.16.a.2 makes Z38 the principal diagnosis for the birth episode on the newborn record. Guideline I.C.16.a.6 requires that all clinically significant conditions noted on routine newborn examination be coded, and this finding meets at least three of the six criteria — therapeutic treatment, extended length of stay, and increased nursing care or monitoring. Under Appendix I, perinatal conditions present at birth or developing in utero are assigned POA indicator Y, because newborns are not considered admitted until after birth.
Guideline: Section I.C.16.a.2, I.C.16.a.6; Appendix I
A 34-year-old is seen for management of a chronic condition documented by the provider as originating in the perinatal period and still present.
Show coded answer & rationale
| Seq | Code | Description |
|---|---|---|
| 1 | P-code | the applicable Chapter 16 code for the condition |
Rationale. Guideline I.C.16.a.1 states that chapter 16 codes may be used throughout the life of the patient if the condition is still present, and I.C.16.a.4 adds that where a condition originates in the perinatal period and continues throughout the life of the patient, the perinatal code should continue to be used regardless of the patient's age. Note the limit at I.C.16.c.2: the separate rule permitting codes for conditions the provider specifies as having implications for future health care needs should not be used for adult patients.
Guideline: Section I.C.16.a.1, I.C.16.a.4, I.C.16.c.2
A newborn delivered by cesarean in hospital tests positive for COVID-19. The provider documents that the infection was contracted in utero.
Show coded answer & rationale
| Seq | Code | Description |
|---|---|---|
| 1 | Z38.01 | Single liveborn infant, delivered by cesarean — principal diagnosis for the birth episode |
| 2 | P35.8 | Other congenital viral diseases |
| 3 | U07.1 | COVID-19 |
| 4 | Manifestations | codes for any associated manifestations in the newborn |
Rationale. Guideline I.C.16.h states that for a newborn testing positive for COVID-19 where the provider documents the condition was contracted in utero or during the birth process, codes P35.8 and U07.1 are assigned, and that when coding the birth episode in a newborn record the appropriate code from category Z38 is assigned as the principal diagnosis. Without documentation of a specific type of transmission, only U07.1 and the manifestation codes would be assigned.
Guideline: Section I.C.16.h, I.C.16.a.2
Primary sources#
- ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027CMS — the source document for every page on this site (effective 1 Oct 2026)
- NCHS ICD-10-CM files — Tabular List, Index, POA exempt listOfficial code files, addenda and the list of codes exempt from POA reporting
- ICD-10 Coordination and Maintenance CommitteeWhere code proposals are debated; agendas, summaries and meeting materials
- CMS ICD-10 homeCode sets, transition guidance and Medicare coding policy
- AHA Coding ClinicOfficial coding advice from the AHA Central Office — subscription required
- HHS OIG Work PlanActive audit topics — useful for prioritising internal coding audits
- MEDESUN Medical Coding AcademyTraining, credential preparation and audit services by the author