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ICD-10 Guide
ICD-10 CodesP05.00

P05.00

Billable

Newborn light for gestational age, unspecified weight

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

Code Description

ICD-10 P05.00 is a billable code used to indicate a diagnosis of newborn light for gestational age, unspecified weight.

Key Diagnostic Point:

P05.00 refers to newborns who are classified as light for gestational age (LGA) but whose specific weight is not documented. This condition is often associated with maternal factors such as inadequate prenatal care, maternal malnutrition, or underlying health conditions like diabetes or hypertension. Delivery complications, including preterm birth or intrauterine growth restriction (IUGR), can also contribute to a newborn being classified as light for gestational age. Clinically, these infants may present with various challenges, including respiratory distress, feeding difficulties, and increased risk of infections. Proper identification and management are crucial, as these newborns may require specialized care in a neonatal intensive care unit (NICU) to monitor their growth and development closely. The coding of this condition necessitates careful documentation of maternal health, delivery complications, and any associated neonatal conditions to ensure accurate coding and appropriate care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal health conditions affecting fetal growth.
  • Need for precise documentation of gestational age and weight.
  • Differentiation from other growth-related codes.
  • Potential for co-morbid conditions requiring additional coding.

Audit Risk Factors

  • Inadequate documentation of maternal health factors.
  • Failure to specify gestational age accurately.
  • Misclassification of weight categories.
  • Omission of associated neonatal conditions.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Infants admitted to NICU for monitoring due to low birth weight or respiratory issues.

Billing Considerations

Ensure that all maternal factors and delivery complications are documented to support the diagnosis.

Pediatrics

Documentation Requirements

Follow-up records detailing growth patterns and developmental milestones.

Common Clinical Scenarios

Pediatric visits for growth monitoring in infants previously classified as light for gestational age.

Billing Considerations

Consider the long-term implications of being light for gestational age on overall health and development.

Coding Guidelines

Inclusion Criteria

Use P05.00 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring that all relevant maternal and neonatal factors are documented
  • Use additional codes to specify any associated conditions or complications

Exclusion Criteria

Do NOT use P05.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

Used for the initial assessment of a newborn classified as light for gestational age.

Documentation Requirements

Document the newborn's weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure comprehensive assessments 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 perinatal conditions, improving the ability to track and manage newborns classified as light for gestational age. This specificity aids in better resource allocation and care planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage newborns classified as light for gestational age. This specificity aids in better resource allocation and care planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage newborns classified as light for gestational age. This specificity aids in better resource allocation and care planning.

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 light for gestational age?

Factors include maternal health issues such as diabetes, hypertension, malnutrition, and delivery complications like preterm birth or intrauterine growth restriction.