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v1.0.0
ICD-10 Guide
ICD-10 CodesP08.1

P08.1

Billable

Other heavy for gestational age newborn

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

Code Description

ICD-10 P08.1 is a billable code used to indicate a diagnosis of other heavy for gestational age newborn.

Key Diagnostic Point:

The ICD-10 code P08.1 refers to newborns who are classified as 'heavy for gestational age' (HGA), which is defined as a birth weight above the 90th percentile for a given gestational age. This condition can arise due to various maternal factors such as obesity, diabetes mellitus, and excessive weight gain during pregnancy. Additionally, delivery complications such as prolonged labor or cesarean delivery may also contribute to the newborn being classified as HGA. Newborns who are heavy for gestational age are at increased risk for several complications, including birth injuries, hypoglycemia, and respiratory distress. Proper documentation of maternal health conditions, delivery details, and newborn assessments is crucial for accurate coding and management of these infants. The clinical team must monitor these infants closely for potential complications and provide appropriate interventions as needed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in defining 'heavy for gestational age' based on population norms.
  • Need for comprehensive maternal history to identify contributing factors.
  • Potential overlap with other codes related to macrosomia and maternal diabetes.
  • Documentation requirements for both maternal and neonatal conditions.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to document delivery complications.
  • Misclassification of birth weight percentiles.
  • Lack of follow-up documentation on newborn outcomes.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

NICU admissions for monitoring of hypoglycemia or respiratory distress in HGA newborns.

Billing Considerations

Close monitoring for potential complications and ensuring accurate coding based on clinical findings.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including growth charts and developmental milestones.

Common Clinical Scenarios

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

Billing Considerations

Consideration of long-term outcomes related to being heavy for gestational age.

Coding Guidelines

Inclusion Criteria

Use P08.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of maternal factors and delivery complications
  • Use additional codes as necessary to capture associated conditions

Exclusion Criteria

Do NOT use P08.1 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 heavy for gestational age newborn in the nursery.

Documentation Requirements

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

Specialty Considerations

Neonatologists should ensure thorough documentation of all assessments.

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 HGA, which aids in better tracking and management of these infants.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including HGA, which aids in better tracking and management of these infants.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including HGA, which aids in better tracking and management of these infants.

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 heavy for gestational age?

Factors include maternal obesity, diabetes, excessive weight gain during pregnancy, and genetic predispositions. Accurate documentation of these factors is essential for proper coding.