P28.5

P28.5: Respiratory failure of newborn

Billable / specific codeICD-10-CM

P28.5 is a billable, specific ICD-10-CM code for respiratory failure of newborn. It is valid for submission on a claim.

Check P28.5 with the rest of the claim: free scrubber

Excludes2: not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

respiratory arrest of newborn (P28.81)
respiratory distress of newborn (P22.0)

Other codes that can never be billed with P28.5

Their own Excludes1 notes name this code, so the conflict is not listed above.

J96Respiratory failure, not elsewhere classified
P22.8Other respiratory distress of newborn
P22.9Respiratory distress of newborn, unspecified
R06Abnormalities of breathing
R09Other symptoms and signs involving the circulatory and respiratory system
R09.2Respiratory arrest

Risk adjustment

P28.5 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 213 Cardio-Respiratory Failure and Shock0.370 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Alphabetic index entries that lead here

Failure, failed›respiration, respiratory›newborn
Inadequate, inadequacy›pulmonary›ventilation, newborn
Insufficiency, insufficient›respiratory›newborn
Respiration›insufficient, or poor›newborn
Inadequate, inadequacy›pulmonary›function›newborn

Code history

Unchanged in every release from FY2024 to FY2027.