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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.07

P05.07

Billable

Newborn light for gestational age, 1750-1999 grams

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

Code Description

ICD-10 P05.07 is a billable code used to indicate a diagnosis of newborn light for gestational age, 1750-1999 grams.

Key Diagnostic Point:

P05.07 refers to newborns who are classified as light for gestational age, weighing between 1750 and 1999 grams at birth. This condition is often associated with various maternal factors such as inadequate prenatal care, maternal malnutrition, smoking, substance abuse, and chronic health conditions like hypertension or diabetes. Delivery complications, including preterm labor and placental insufficiency, can also contribute to low birth weight. Newborns in this category are at increased risk for several health issues, including respiratory distress syndrome, hypoglycemia, and thermoregulation problems. Close monitoring and specialized care in a neonatal intensive care unit (NICU) may be required to address these risks and ensure optimal growth and development. Accurate coding of this condition is crucial for appropriate management and resource allocation in neonatal care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of maternal health factors
  • Failure to specify gestational age
  • Misclassification of birth weight categories
  • Inconsistent coding of co-morbid conditions

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Management of respiratory distress, feeding difficulties, and temperature instability in the NICU.

Billing Considerations

Ensure accurate tracking of growth parameters and developmental milestones.

Pediatrics

Documentation Requirements

Comprehensive history of maternal health and newborn assessments.

Common Clinical Scenarios

Follow-up care for growth and development in outpatient settings.

Billing Considerations

Monitor for long-term effects of low birth weight on health outcomes.

Coding Guidelines

Inclusion Criteria

Use P05.07 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and birth weight
  • Use additional codes for any associated conditions

Exclusion Criteria

Do NOT use P05.07 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, newborn

Clinical Scenario

Used for the initial assessment of a newborn weighing 1800 grams in the NICU.

Documentation Requirements

Document birth weight, gestational age, and any immediate complications.

Specialty Considerations

Neonatologists should ensure comprehensive assessments are documented.

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 low birth weight infants and their associated risks.

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 low birth weight infants and their associated risks.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage low birth weight infants and their associated risks.

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 key factors to document for P05.07?

Key factors include the newborn's weight, gestational age, maternal health history, and any complications during delivery. Accurate documentation is essential for proper coding and management.