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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.0

P05.0

Billable

Newborn light for gestational age

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

Code Description

ICD-10 P05.0 is a billable code used to indicate a diagnosis of newborn light for gestational age.

Key Diagnostic Point:

P05.0 refers to newborns who are classified as light for gestational age (LGA), indicating that they weigh less than the 10th percentile for their gestational age. This condition can arise from various maternal factors such as poor nutrition, smoking, alcohol consumption, or chronic health issues like hypertension or diabetes. Delivery complications, including placental insufficiency or preterm birth, can also contribute to a newborn being classified as LGA. These infants may face increased risks for developmental delays, respiratory distress, and other health complications. Accurate coding is essential for appropriate management and follow-up care, as it helps healthcare providers identify at-risk infants and implement necessary interventions. The clinical management of these newborns often involves close monitoring in a neonatal intensive care unit (NICU) setting, where specialized care can be provided to address their unique needs.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in gestational age assessment methods
  • Differentiation between LGA and other weight classifications
  • Impact of maternal health conditions on newborn weight
  • Documentation of delivery complications

Audit Risk Factors

  • Inadequate documentation of maternal factors
  • Failure to specify gestational age accurately
  • Misclassification of newborn weight categories
  • Lack of follow-up documentation for LGA infants

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of birth weight, gestational age, and maternal health history are essential. Documentation should also include any complications during delivery and immediate postnatal care.

Common Clinical Scenarios

Common scenarios include monitoring LGA infants for hypoglycemia, respiratory distress, and ensuring proper feeding protocols are followed.

Billing Considerations

Neonatologists must ensure that all relevant maternal factors are documented to support the coding of P05.0 accurately.

Pediatrics

Documentation Requirements

Pediatricians should document growth patterns, developmental milestones, and any interventions required for LGA infants.

Common Clinical Scenarios

Pediatric follow-ups may include assessing for developmental delays or complications arising from being LGA.

Billing Considerations

Pediatricians should be aware of the long-term implications of being LGA and document any ongoing care needs.

Coding Guidelines

Inclusion Criteria

Use P05.0 When
  • Perinatal coding guidelines emphasize the importance of accurate gestational age determination and the need for comprehensive maternal health documentation
  • Newborn
  • specific criteria include weight measurements and growth percentiles

Exclusion Criteria

Do NOT use P05.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

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

Documentation Requirements

Documentation must include weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure comprehensive documentation to support the coding.

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 and manage LGA infants effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage LGA infants effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage LGA infants effectively.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Frequently Asked Questions

What are the implications of coding P05.0 for newborn care?

Coding P05.0 indicates that the newborn is light for gestational age, which can impact care decisions, monitoring protocols, and follow-up assessments. It is crucial for identifying infants at risk for complications and ensuring appropriate interventions are in place.