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

P05.10

Billable

Newborn small for gestational age, unspecified weight

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

Code Description

ICD-10 P05.10 is a billable code used to indicate a diagnosis of newborn small for gestational age, unspecified weight.

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. This condition can arise from various maternal factors, including inadequate maternal nutrition, chronic maternal diseases (such as hypertension or diabetes), and placental insufficiency. Delivery complications, such as preterm birth or intrauterine growth restriction (IUGR), can also contribute to SGA status. Accurate identification and coding of SGA are crucial as it may indicate underlying health issues that require close monitoring and intervention. Newborns who are SGA are at increased risk for perinatal morbidity and mortality, necessitating careful assessment and management in the neonatal period. Clinicians must document the specific maternal factors and delivery complications that may have contributed to the newborn's SGA status to ensure appropriate coding and care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal health conditions affecting fetal growth.
  • Need for precise gestational age determination.
  • Differentiation between SGA and other growth-related conditions.
  • Documentation of maternal factors and delivery complications.

Audit Risk Factors

  • Inadequate documentation of maternal health history.
  • Failure to specify gestational age accurately.
  • Misinterpretation of SGA versus IUGR.
  • Inconsistent coding practices across different healthcare settings.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of birth weight, gestational age, and maternal health factors.

Common Clinical Scenarios

NICU admissions for SGA infants requiring monitoring for hypoglycemia or respiratory distress.

Billing Considerations

Consideration of potential long-term developmental impacts of being SGA.

Pediatrics

Documentation Requirements

Comprehensive growth charts and developmental assessments.

Common Clinical Scenarios

Follow-up visits for SGA infants to monitor growth and development.

Billing Considerations

Awareness of the increased risk for chronic health issues in SGA children.

Coding Guidelines

Inclusion Criteria

Use P05.10 When
  • Coders should refer to the ICD
  • CM coding guidelines for perinatal conditions, ensuring that all relevant maternal factors and delivery complications are documented
  • Accurate gestational age and weight assessments are critical for proper coding

Exclusion Criteria

Do NOT use P05.10 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 when an SGA newborn is evaluated in the nursery.

Documentation Requirements

Document the newborn's weight, gestational age, and any 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, including SGA, which helps in better tracking and management of affected newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including SGA, which helps in better tracking and management of affected newborns.

Reimbursement & Billing Impact

reimbursement and quality care.

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 factors contribute to a newborn being classified as SGA?

Factors include maternal health conditions such as hypertension, diabetes, malnutrition, and placental insufficiency. Delivery complications like preterm birth can also contribute.