P91.63

Billable

Severe hypoxic ischemic encephalopathy [HIE]

HCC Category Mapping

V28HCC 202 — Coma, Brain Compression/Anoxic Damage

0.000

What This Code Means

A newborn's severe brain injury from oxygen and blood deprivation, typically resulting in significant neurological complications including persistent seizures, coma, or profound developmental impairment.

Coding Tips

•Document severe clinical indicators such as status epilepticus, deep coma, or need for intensive life support
•Ensure clear documentation of severity assessment and any therapeutic interventions like hypothermia therapy used to treat the condition

Clinical Significance

Severe HIE represents the most devastating form of perinatal brain injury with profound neurological compromise and very high mortality risk. This diagnosis indicates extremely poor prognosis with likelihood of severe cerebral palsy, intellectual disability, and lifelong care dependency.

Documentation Requirements

✓Specific documentation of severe HIE with Sarnat stage III criteria
✓Profound neurological depression or coma documented
✓Severe hypotonia and absent or severely abnormal reflexes
✓Persistent seizures often refractory to treatment
✓Neuroimaging showing extensive brain injury
✓EEG showing severe abnormalities or burst suppression
✓Poor response to therapeutic hypothermia
✓Multiorgan dysfunction often present

Commonly Confused Codes

P91.62 — Moderate HIE, less severe neurological compromise P91.5 — Neonatal coma, may be component of severe HIE P91.60 — HIE unspecified, when severe grade clearly documented G93.1 — Anoxic brain damage, not neonatal-specific

Code Hierarchy

└P91Other disturbances of cerebral status of newborn └P91.6Hypoxic ischemic encephalopathy [HIE]└P91.63Severe hypoxic ischemic encephalopathy [HIE]

└P91.63Severe hypoxic ischemic encephalopathy [HIE]