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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.18

P05.18

Billable

Newborn small for gestational age, 2000-2499 grams

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

Code Description

ICD-10 P05.18 is a billable code used to indicate a diagnosis of newborn small for gestational age, 2000-2499 grams.

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. Specifically, P05.18 refers to infants weighing between 2000 and 2499 grams at birth. This condition can arise due to various maternal factors such as inadequate nutrition, placental insufficiency, or maternal health issues like hypertension or diabetes. Delivery complications, including preterm birth or intrauterine growth restriction (IUGR), can also contribute to SGA status. These infants are at increased risk for perinatal morbidity and mortality, necessitating careful monitoring and management in the neonatal period. Clinical assessment often includes evaluating growth parameters, conducting metabolic screenings, and monitoring for potential complications such as hypoglycemia or respiratory distress. Understanding the underlying causes and implications of SGA is crucial for optimizing care and improving outcomes for affected newborns.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in gestational age assessment
  • Differentiation between SGA and IUGR
  • Maternal health history documentation
  • Potential for co-morbid conditions

Audit Risk Factors

  • Inadequate documentation of maternal health factors
  • Failure to specify gestational age
  • Misclassification of weight categories
  • Lack of follow-up documentation on infant outcomes

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Management of SGA infants in the NICU, including monitoring for hypoglycemia and respiratory issues.

Billing Considerations

Consideration of maternal factors and delivery complications that may have contributed to SGA status.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including growth charts and developmental milestones.

Common Clinical Scenarios

Follow-up care for SGA infants in outpatient settings, monitoring growth and development.

Billing Considerations

Awareness of long-term outcomes associated with SGA status and the need for ongoing assessments.

Coding Guidelines

Inclusion Criteria

Use P05.18 When
  • 10 coding guidelines specify that the diagnosis of SGA must be supported by accurate birth weight and gestational age documentation
  • Coders should ensure that maternal factors contributing to SGA are clearly documented

Exclusion Criteria

Do NOT use P05.18 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 an SGA infant in the nursery.

Documentation Requirements

Document weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure comprehensive evaluations are performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of SGA conditions, improving the granularity of data collection and enhancing the ability to track outcomes and resource utilization in neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of SGA conditions, improving the granularity of data collection and enhancing the ability to track outcomes and resource utilization in neonatal care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of SGA conditions, improving the granularity of data collection and enhancing the ability to track outcomes and resource utilization in neonatal care.

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 factors contribute to a newborn being classified as SGA?

Factors include maternal health issues such as hypertension, diabetes, nutritional deficiencies, and placental insufficiency. Environmental factors like smoking and substance abuse can also play a significant role.