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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.12

P05.12

Billable

Newborn small for gestational age, 500-749 grams

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P05.12 is a billable code used to indicate a diagnosis of newborn small for gestational age, 500-749 grams.

Key Diagnostic Point:

Newborns classified as small for gestational age (SGA) are those whose birth weight is below the 10th percentile for their gestational age. The specific code P05.12 refers to newborns weighing between 500 and 749 grams, indicating a significant risk for various health complications. SGA can result from maternal factors such as inadequate nutrition, chronic health conditions (e.g., hypertension, diabetes), or substance abuse during pregnancy. Delivery complications, including placental insufficiency or preterm labor, can also contribute to SGA. These infants often require specialized care in a Neonatal Intensive Care Unit (NICU) due to their increased vulnerability to hypothermia, hypoglycemia, respiratory distress, and infection. Early identification and management of SGA are crucial to improve outcomes, necessitating close monitoring and intervention to address potential complications.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between SGA due to maternal factors versus congenital anomalies.
  • Understanding the implications of gestational age on coding.
  • Navigating the documentation requirements for maternal health conditions.
  • Identifying associated complications that may require additional coding.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to document the infant's weight accurately.
  • Misclassification of SGA versus other growth-related conditions.
  • Lack of clarity in the clinical rationale for SGA diagnosis.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of birth weight, gestational age, and any complications during delivery.

Common Clinical Scenarios

Management of SGA infants in the NICU, including monitoring for hypoglycemia and respiratory support.

Billing Considerations

Consideration of maternal health history and delivery complications in coding.

Pediatrics

Documentation Requirements

Comprehensive follow-up documentation on growth and developmental milestones.

Common Clinical Scenarios

Pediatric assessments of SGA infants for growth tracking and developmental delays.

Billing Considerations

Awareness of long-term outcomes associated with SGA and the need for ongoing monitoring.

Coding Guidelines

Inclusion Criteria

Use P05.12 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age, birth weight, and any maternal factors contributing to SGA

Exclusion Criteria

Do NOT use P05.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, per day, for evaluation and management of a normal newborn infant

Clinical Scenario

Used for initial assessment of an SGA infant in the NICU.

Documentation Requirements

Document the infant's weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure comprehensive documentation of the infant's condition.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of SGA and its associated complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of SGA and its associated complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the nuances of SGA and its associated complications.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding in Neonatology

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding in Neonatology

Frequently Asked Questions

What factors contribute to a newborn being classified as SGA?

Factors include maternal health conditions such as hypertension, diabetes, nutritional deficiencies, and placental insufficiency. Additionally, genetic factors and multiple gestations can also contribute.