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v1.0.0
ICD-10 Guide
ICD-10 CodesP01.5

P01.5

Billable

Newborn affected by multiple pregnancy

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

Code Description

ICD-10 P01.5 is a billable code used to indicate a diagnosis of newborn affected by multiple pregnancy.

Key Diagnostic Point:

P01.5 refers to newborns who are affected by complications arising from multiple pregnancies, such as twins or higher-order multiples. These newborns may experience a range of health issues due to maternal complications during pregnancy, including an incompetent cervix, which can lead to preterm birth, and premature rupture of membranes (PROM), which increases the risk of infection and other complications. The presence of multiple fetuses can complicate the pregnancy further, leading to conditions such as twin-to-twin transfusion syndrome or intrauterine growth restriction. Newborns affected by these conditions may require specialized care in a Neonatal Intensive Care Unit (NICU) to monitor for respiratory distress, feeding difficulties, and other potential complications. Accurate coding is essential for appropriate management and reimbursement, as well as for tracking outcomes in this vulnerable population.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation among multiple births
  • Need for detailed maternal history and complications
  • Potential for co-morbid conditions requiring additional coding
  • Documentation of gestational age and birth weight

Audit Risk Factors

  • Inadequate documentation of maternal complications
  • Failure to specify the number of fetuses
  • Misclassification of the newborn's condition
  • Lack of follow-up documentation for NICU stays

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of gestational age, birth weight, and any complications during delivery or in the NICU.

Common Clinical Scenarios

Management of preterm twins with respiratory distress syndrome or feeding intolerance.

Billing Considerations

Ensure accurate tracking of each twin's health status and any interventions provided.

Pediatrics

Documentation Requirements

Comprehensive history of maternal health and any complications during pregnancy.

Common Clinical Scenarios

Follow-up care for twins with developmental delays or other long-term effects of prematurity.

Billing Considerations

Consider the impact of multiple births on developmental milestones and health outcomes.

Coding Guidelines

Inclusion Criteria

Use P01.5 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that all relevant maternal complications are documented and that the newborn's condition is accurately reflected in the coding

Exclusion Criteria

Do NOT use P01.5 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

Clinical Scenario

Used for initial assessment of a newborn affected by multiple pregnancy complications.

Documentation Requirements

Document the newborn's condition, gestational age, and any immediate interventions.

Specialty Considerations

Neonatologists should ensure detailed notes on the newborn's response to care.

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 track outcomes and manage care for newborns affected by multiple pregnancies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track outcomes and manage care for newborns affected by multiple pregnancies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track outcomes and manage care for newborns affected by multiple pregnancies.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common complications for newborns affected by multiple pregnancies?

Common complications include respiratory distress syndrome, feeding difficulties, and increased risk of infections. These newborns often require close monitoring and specialized care in a NICU setting.