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ICD-10 Guide
ICD-10 CodesP05.05

P05.05

Billable

Newborn light for gestational age, 1250-1499 grams

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

Code Description

ICD-10 P05.05 is a billable code used to indicate a diagnosis of newborn light for gestational age, 1250-1499 grams.

Key Diagnostic Point:

P05.05 refers to newborns who are classified as light for gestational age, specifically those weighing between 1250 and 1499 grams at birth. This condition is often associated with intrauterine growth restriction (IUGR), which can result from various maternal factors such as poor nutrition, smoking, substance abuse, or chronic health conditions like hypertension and diabetes. Delivery complications, including preterm labor and placental insufficiency, can also contribute to low birth weight. Newborns in this weight category are at increased risk for a range of health issues, including respiratory distress syndrome, hypoglycemia, and temperature instability. Close monitoring and specialized care in a neonatal intensive care unit (NICU) are often required to address these potential complications and support the infant's growth and development.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal health factors affecting fetal growth
  • Differentiation between preterm and term infants with low birth weight
  • Need for detailed documentation of maternal history and delivery complications
  • Potential for co-morbid conditions requiring additional coding

Audit Risk Factors

  • Inadequate documentation of maternal health conditions
  • Failure to specify gestational age accurately
  • Misclassification of birth weight categories
  • Omission of relevant delivery complications

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Infants requiring respiratory support due to prematurity or IUGR, management of hypoglycemia, and monitoring for infection.

Billing Considerations

Accurate coding requires understanding of the infant's clinical status and maternal history, including any interventions during pregnancy.

Pediatrics

Documentation Requirements

Documentation of growth parameters, developmental milestones, and follow-up care plans.

Common Clinical Scenarios

Pediatric follow-up for growth assessment, management of developmental delays, and addressing any ongoing health issues stemming from low birth weight.

Billing Considerations

Pediatric coders must be aware of the long-term implications of low birth weight on health outcomes and development.

Coding Guidelines

Inclusion Criteria

Use P05.05 When
  • Coders should adhere to the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age, birth weight, and any associated maternal factors or delivery complications

Exclusion Criteria

Do NOT use P05.05 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 classified under P05.05 in the NICU.

Documentation Requirements

Documentation must include weight, gestational age, and any complications noted during the initial assessment.

Specialty Considerations

Neonatologists should ensure comprehensive documentation to support the medical necessity of the services provided.

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 low birth weight and associated complications, which enhances data accuracy and patient care.

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 low birth weight and associated complications, which enhances data accuracy and patient care.

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 low birth weight and associated complications, which enhances data accuracy and patient care.

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 are the key factors to consider when coding P05.05?

Key factors include accurate documentation of the newborn's weight and gestational age, maternal health conditions, and any delivery complications. Coders should ensure that all relevant information is captured to support the diagnosis and any associated procedures.