Apnea of Prematurity CDI Coding Considerations

What is apnea of prematurity?

A condition commonly associated with the newborn requiring NICU level of care. This is related to the immature development of the respiratory system. Severity and frequency are related to the gestational age. A large proportion of extremely preterm (<28 weeks GA) or have birthweight that is extremely low (<1000 grams) will demonstrate apnea of prematurity.

Clinical Indicators of Apnea of Prematurity

Apneic spells are typically defined as the cessation of breathing for >/= 20 seconds or longer. A shorter pause that is accompanied by hypoxia and/or bradycardia (<100 BPM), cyanosis or pallor also meets this threshold

Types of apnea of prematurity include:

• Central – Defined by the cessation of breathing
• Obstructive – Airflow is obstructed typically at the pharynx
• Mixed – Describes the obstructed airflow leading to central apneic pause, or vice versa.

Mixed apnea comprises the majority of apneic episodes in preterm infants.

Treatment Approaches for Apnea of Prematurity

(May be selected based on gestational age and the severity of apnea) 

• Respiratory support is the focus 
• nCPAP 
• NIPPV 
• Mechanical ventilation 
• Methylxanthines (caffeine and theophylline) 

Coding and CDI Considerations for Apnea of Prematurity

• Subcategory P28.4-, Other apnea of newborn 
• These codes provide a CC/OSP (Other Significant Problem) and SOI of 2 
• When apnea is persistent and requires respiratory support listed in the treatments above, the CDS should review any indicators of respiratory failure. 
• It is appropriate to query if respiratory failure indicators unique to the newborn patient are identified. 



Alyce Reavis, RN,MSN,CCDS,CCS 

Senior CDI Educator, Consulting Services at UASI

Drawing on clinical experience in adult, pediatric, and neonatal acute care, Alyce brings valuable insight to CDI education and documentation improvement. She holds an MSN in Leadership/Education along with CCDS, CCS, and AHIMA’s outpatient CDI micro credential, supporting health systems in strengthening documentation accuracy, quality reporting, and reimbursement integrity. Passionate about truthful, clinically aligned health records, she helps organizations ensure documentation reflects true patient acuity. She is a past presenter for the ACDIS National Convention, Local chapter meetings, and the ACDIS Virtual Best Practices conference. 

Works Cited

Manz, J., Prescott, L. ACDIS CDI Pocket Guide. 2025. Apnea of Prematurity [Neonatal]. Pocket Resource Online.

Martin, R. Management of Apnea of Prematurity. UpToDate. May 30, 2025. Available at: https://www.uptodate.com/contents/management-of-apnea-of-prematurity

Zivaljevic, J., Jovandaric, M. Z., Babic, S., & Raus, M. Complications of Preterm Birth—The Importance of Care for the Outcome: A Narrative Review. Medicina. 2024;60(6):1014. Available at: https://doi.org/10.3390/medicina60061014