P52.22

Billable

Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn

HCC Category Mapping

V28HCC 248 — Cerebral Hemorrhage

0.289

What This Code Means

Severe bleeding inside the brain ventricles (fluid-filled spaces) in a newborn, classified as the most severe grade (grade 4), occurring without trauma.

Coding Tips

•Grade 4 represents the most severe intraventricular hemorrhage with ventricular dilation; ensure the grade is documented in the medical record before coding
•This code is specific to nontraumatic hemorrhage; if trauma is involved, use a different code category

Clinical Significance

Grade 4 intraventricular hemorrhage represents the most severe form of neonatal brain bleeding, extending into brain parenchyma with significant tissue destruction. This condition carries extremely high risk for severe neurodevelopmental impairment, cerebral palsy, and death, requiring intensive neurological care and often leading to lifelong disabilities requiring comprehensive support services.

Documentation Requirements

✓Head ultrasound or MRI confirming Grade 4 IVH
✓Evidence of parenchymal hemorrhagic infarction
✓Gestational age and birth weight
✓Extent of brain tissue involvement
✓Associated ventricular dilatation
✓Neurological examination findings
✓Neurosurgical evaluation
✓Prognosis and care planning documentation

Commonly Confused Codes

P52.21 — Grade 3 IVH, severe but without parenchymal involvement P52.4 — Intracerebral hemorrhage, different bleeding pattern P52.8 — Other intracranial hemorrhages G93.1 — Anoxic brain damage, different etiology

Code Hierarchy

└P52Intracranial nontraumatic hemorrhage of newborn └P52.2Intraventricular (nontraumatic) hemorrhage, grade 3 and grade 4, of newborn └P52.22Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn

└P52.22Intraventricular (nontraumatic) hemorrhage, grade 4, of newborn