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v1.0.0
ICD-10 Guide
ICD-10 CodesP07.15

P07.15

Billable

Other low birth weight newborn, 1250-1499 grams

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

Code Description

ICD-10 P07.15 is a billable code used to indicate a diagnosis of other low birth weight newborn, 1250-1499 grams.

Key Diagnostic Point:

P07.15 is used to classify newborns who weigh between 1250 and 1499 grams at birth, indicating a low birth weight status. Low birth weight can arise from various maternal factors, including inadequate prenatal care, maternal malnutrition, smoking, substance abuse, and chronic health conditions such as hypertension or diabetes. Delivery complications, such as preterm labor or placental insufficiency, can also contribute to low birth weight. Newborns in this category are at increased risk for a range of health issues, including respiratory distress syndrome, infections, and long-term developmental challenges. Care for these infants often requires specialized neonatal intensive care, including thermal regulation, nutritional support, and monitoring for complications. Accurate coding is essential for appropriate reimbursement and to ensure that these vulnerable patients receive the necessary care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal health conditions affecting birth weight
  • Differentiation between low birth weight and other weight categories
  • Documentation of delivery complications
  • Need for precise weight measurement at birth

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to document delivery complications
  • Incorrect weight classification at birth
  • Lack of follow-up documentation for neonatal outcomes

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 NICU admission for respiratory support, feeding difficulties, or monitoring for infections.

Billing Considerations

Ensure accurate weight measurement and documentation of any interventions or complications.

Pediatrics

Documentation Requirements

Comprehensive history of maternal health, delivery details, and ongoing assessments of growth and development.

Common Clinical Scenarios

Follow-up visits for developmental milestones, nutritional assessments, and management of chronic conditions.

Billing Considerations

Consider the long-term implications of low birth weight on pediatric health and development.

Coding Guidelines

Inclusion Criteria

Use P07.15 When
  • Follow the official ICD
  • CM coding guidelines for perinatal conditions, ensuring accurate documentation of birth weight, gestational age, and any maternal or delivery complications

Exclusion Criteria

Do NOT use P07.15 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 low birth weight newborn in the NICU.

Documentation Requirements

Document weight, gestational age, and any immediate interventions.

Specialty Considerations

Neonatologists should ensure thorough documentation of all assessments and interventions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of low birth weight categories, improving the ability to capture the nuances of neonatal care and ensuring appropriate reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of low birth weight categories, improving the ability to capture the nuances of neonatal care and ensuring appropriate reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 under P07.15?

Factors include maternal health conditions such as diabetes or hypertension, inadequate prenatal care, substance abuse, and complications during delivery that may restrict fetal growth.