P22.9 vs P28.5
P22.9 and P28.5 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on P22.9
respiratory failure of newborn NOS (P28.5)
P22.9
Respiratory distress of newborn, unspecified
BillableUnspecified
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P19-P29
Indexed under
- Distress › respiratory › newborn
P28.5
Respiratory failure of newborn
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P19-P29
Indexed under
- Failure, failed › respiration, respiratory › newborn
- Inadequate, inadequacy › pulmonary › ventilation, newborn
- Insufficiency, insufficient › respiratory › newborn
- Respiration › insufficient, or poor › newborn
- Inadequate, inadequacy › pulmonary › function › newborn
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027