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ICD-10 Guide
ICD-10 CodesP05.11

P05.11

Billable

Newborn small for gestational age, less than 500 grams

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

Code Description

ICD-10 P05.11 is a billable code used to indicate a diagnosis of newborn small for gestational age, less than 500 grams.

Key Diagnostic Point:

P05.11 refers to newborns who are classified as small for gestational age (SGA) and weigh less than 500 grams at birth. This condition is often associated with intrauterine growth restriction (IUGR), which can result from various maternal factors such as poor nutrition, chronic diseases (like hypertension or diabetes), substance abuse, or placental insufficiency. Newborns in this category are at a significantly higher risk for complications, including respiratory distress syndrome, hypoglycemia, and increased susceptibility to infections. The management of these infants typically requires specialized neonatal care, often in a NICU setting, where they can receive close monitoring and interventions to support their growth and development. Accurate coding of this condition is crucial for appropriate resource allocation and understanding the epidemiology of SGA infants.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between SGA and other growth-related conditions
  • Understanding maternal health factors contributing to SGA
  • Documenting precise birth weight and gestational age
  • Identifying associated complications and comorbidities

Audit Risk Factors

  • Inadequate documentation of birth weight and gestational age
  • Failure to link maternal conditions to newborn outcomes
  • Misclassification of SGA versus other growth disorders
  • Omission of associated complications in coding

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of birth weight, gestational age, and maternal health history are essential.

Common Clinical Scenarios

Infants born to mothers with gestational diabetes or hypertension, requiring NICU admission for monitoring.

Billing Considerations

Ensure accurate coding of any associated complications such as hypoglycemia or respiratory distress.

Pediatrics

Documentation Requirements

Pediatricians must document growth parameters and developmental milestones during follow-up visits.

Common Clinical Scenarios

Follow-up care for SGA infants with potential developmental delays or health issues.

Billing Considerations

Consider the long-term implications of being SGA on pediatric growth and development.

Coding Guidelines

Inclusion Criteria

Use P05.11 When
  • Follow the ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and birth weight
  • Utilize additional codes for any associated complications

Exclusion Criteria

Do NOT use P05.11 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 evaluation of SGA infants in the NICU.

Documentation Requirements

Document birth 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, improving the ability to capture the nuances of SGA and its associated complications.

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 SGA and its associated complications.

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 SGA and its associated complications.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding Newborns

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding Newborns

Frequently Asked Questions

What is the significance of coding P05.11 accurately?

Accurate coding of P05.11 is crucial for appropriate resource allocation, understanding the epidemiology of SGA infants, and ensuring that infants receive the necessary care and follow-up.