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P28.42 ICD-10-CM Code: Obstructive apnea of newborn

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes2 · 1 code-also instruction

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P28.42 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on P28.42 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from P28.4

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable, congenital malformations of the respiratory system (Q30-Q34)

Source: inherited from P28

Coder workflow for P28.42

MedCoder structured workflow — derived from this code’s own official record

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes2 — not part of P28.42(1 note)

    Coding workflow: The conditions named in this note are not included in P28.42. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareP28.3

    See the official tabular notes · Guidelines I.A.12.b

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse P28.42 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of P28.42 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • P28.40— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Unspecified apnea of newborn” takes P28.40; specificity in the record moves it back here.

    Full comparison: P28.42 vs P28.40 →

  • P28.3— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of primary sleep apnea of newborn adds P28.3; it is not part of this code and both may be reported when both are documented.

    Full comparison: P28.42 vs P28.3 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Obstructive apnea of newborn is a billable ICD-10-CM diagnosis code (P28.42).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name P28.42 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 5 Excludes1 notes across 4 chapters: J98 — Other respiratory disorders (via P28.4.-), P28.2 — Cyanotic attacks of newborn (via P28.4.-), R06.81 — Apnea, not elsewhere classified (via P28.4.-), Z03.83 — Encounter for observation for suspected conditions related to home physiologic monitoring device ruled out (via P28.4.-), Z05.81 — Observation and evaluation of newborn for suspected condition related to home physiologic monitoring device ruled out (via P28.4.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: P28.3 — Primary sleep apnea of newborn (via P28.4.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 17 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 794 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PNL006 — Respiratory perinatal condition (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

P22.8 — Other respiratory distress of newborn, P22.9 — Respiratory distress of newborn, unspecified, P28.2 — Cyanotic attacks of newborn, P28.30 — Primary sleep apnea of newborn, unspecified, P28.31 — Primary central sleep apnea of newborn, P28.32 — Primary obstructive sleep apnea of newborn, P28.33 — Primary mixed sleep apnea of newborn, P28.39 — Other primary sleep apnea of newborn, P28.40 — Unspecified apnea of newborn, P28.41 — Central neonatal apnea of newborn, P28.43 — Mixed neonatal apnea of newborn, P28.49 — Other apnea of newborn, P28.81 — Respiratory arrest of newborn, P28.89 — Other specified respiratory conditions of newborn, P28.9 — Respiratory condition of newborn, unspecified, R06.81 — Apnea, not elsewhere classified

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Respiratory perinatal condition).

P28.0 — Primary atelectasis of newborn, P28.10 — Unspecified atelectasis of newborn, P28.11 — Resorption atelectasis without respiratory distress syndrome, P28.19 — Other atelectasis of newborn, P28.2 — Cyanotic attacks of newborn, P28.3 — Primary sleep apnea of newborn, P28.30 — Primary sleep apnea of newborn, unspecified, P28.31 — Primary central sleep apnea of newborn, P28.32 — Primary obstructive sleep apnea of newborn, P28.33 — Primary mixed sleep apnea of newborn, P28.39 — Other primary sleep apnea of newborn, P28.4 — Other apnea of newborn, P28.40 — Unspecified apnea of newborn, P28.41 — Central neonatal apnea of newborn, P28.43 — Mixed neonatal apnea of newborn, P28.49 — Other apnea of newborn, P28.5 — Respiratory failure of newborn, P28.81 — Respiratory arrest of newborn, P28.89 — Other specified respiratory conditions of newborn, P28.9 — Respiratory condition of newborn, unspecified, +33 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Newborn”; these codes share that main term but sit in a different category of the Tabular List.

P04.49 — Newborn affected by maternal use of other drugs of addiction (affected by, methamphetamine), P04.5 — Newborn affected by maternal use of nutritional chemical substances (affected by, nutritional supplements), P04.6 — Newborn affected by maternal exposure to environmental chemical substances (affected by, environmental chemicals), P04.81 — Newborn affected by maternal use of cannabis (affected by, maternal, cannabis), P04.89 — Newborn affected by other maternal noxious substances (affected by, noxious substances transmitted via placenta or breast milk, specified NEC), P04.9 — Newborn affected by maternal noxious substance, unspecified (affected by, noxious substances transmitted via placenta or breast milk), P05.2 — Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age (affected by, fetal, malnutrition not light or small for gestational age), P05.9 — Newborn affected by slow intrauterine growth, unspecified (affected by, slow intrauterine growth), P08.21 — Post-term newborn (post-term), P08.22 — Prolonged gestation of newborn (prolonged gestation), P29.11 — Neonatal tachycardia (affected by, heart rate abnormalities, tachycardia), P29.12 — Neonatal bradycardia (affected by, heart rate abnormalities, bradycardia), P29.81 — Cardiac arrest of newborn (affected by, cardiac arrest), P36.0 — Sepsis of newborn due to streptococcus, group B (sepsis, due to, Streptococcus, group B), P36.10 — Sepsis of newborn due to unspecified streptococci (sepsis, due to, Streptococcus), P36.19 — Sepsis of newborn due to other streptococci (sepsis, due to, Streptococcus, specified NEC), P36.2 — Sepsis of newborn due to Staphylococcus aureus (sepsis, due to, Staphylococcus, aureus), P36.30 — Sepsis of newborn due to unspecified staphylococci (sepsis, due to, Staphylococcus), P36.39 — Sepsis of newborn due to other staphylococci (sepsis, due to, Staphylococcus, specified NEC), P36.4 — Sepsis of newborn due to Escherichia coli (sepsis, due to, Escherichia coli), +150 more

Contextual Map

Every relationship of P28.42 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run P28.42 with these 6 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS[MS-DRG]: “NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

Index entries

  • Apnea, apneic (of) (spells), newborn, obstructive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Newborn (infant) (liveborn) (singleton), apnea, obstructive[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (23)

Change history

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "P28.42 — Obstructive apnea of newborn." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/p28.42-obstructive-apnea-of-newborn

Change history

  • FY2023 — October 1, 2022
    Added to the code set
    Obstructive apnea of newborn
    FY2023 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P28.42 in its code family, with their registry titles.

View all codes in the P28 family