Neonatal metabolic bone disease (MBD)

Created Sep 2022
Effective from 1 Jul 2022


We would like clarification on what diagnosis code to assign for neonatal metabolic bone disease or metabolic bone disease of prematurity.

The Starship metabolic bone disease guidelines state:

“Neonatal metabolic bone disease (MBD), osteopenia of prematurity, neonatal rickets or rickets of prematurity, are terms used to describe a reduction in bone mineral content which may occur 4 - 6 weeks after preterm birth.

MBD presents between 6 and 12 weeks after birth but may be asymptomatic for weeks until severe demineralisation occurs, presenting as overt rickets or fractures.  Symptoms may include poor weight gain, faltering growth, and respiratory difficulties or failure to wean off ventilatory support due to excessive chest wall compliance.  Fractures may manifest as pain on handling. Early recognition of MBD is important for nutritional management in preterm infants.

The diagnosis of MBD remains largely subjective because most babies do not manifest overt signs or symptoms. Diagnosis has been based on criteria that include clinical signs, biochemical markers, and measurement of bone mineral content and radiologic findings (a late sign).” – Metabolic bone disease – Starship


For clinical documentation of neonatal metabolic bone disease or metabolic bone disease of prematurity assign code P74.8 Other transitory metabolic disturbances of newborn following the ICD-10-AM Alphabetic Index: Disturbance/metabolism/neonatal, transitory/specified NEC P74.8.  Please use free text to specify ‘neonatal metabolic bone disease’ or ‘metabolic bone disease of prematurity’.

Clinical consultation with a neonatologist confirmed code P74.8 was the most appropriate code available in ICD-10-AM and it is also consistent with how the condition is classified in ICD-11.

A coding query has been raised with the Independent Health and Aged Care Pricing Authority (IHACPA) to confirm code assignment.

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