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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.01

P05.01

Billable

Newborn light for gestational age, less than 500 grams

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

Code Description

ICD-10 P05.01 is a billable code used to indicate a diagnosis of newborn light for gestational age, less than 500 grams.

Key Diagnostic Point:

P05.01 refers to newborns who are classified as light for gestational age (LGA) and weigh less than 500 grams at birth. This condition is often associated with intrauterine growth restriction (IUGR) and can be influenced by various maternal factors such as poor nutrition, chronic illnesses, or placental insufficiency. Newborns in this category are at a significantly higher risk for complications, including respiratory distress syndrome, hypothermia, and infections. The management of these infants typically requires specialized neonatal care in a NICU setting, where they can receive interventions such as thermal regulation, nutritional support, and monitoring for potential complications. Accurate coding of this condition is crucial for appropriate reimbursement and resource allocation in neonatal care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Differentiating between IUGR and other causes of low birth weight
  • Understanding maternal health factors impacting fetal growth
  • Identifying associated complications that require additional coding
  • Navigating documentation requirements for NICU admissions

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to capture associated complications
  • Incorrect assignment of weight categories
  • Misinterpretation of gestational age

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of birth weight, gestational age, and any complications observed in the NICU.

Common Clinical Scenarios

Management of extremely low birth weight infants, monitoring for respiratory distress, and nutritional support strategies.

Billing Considerations

Ensure accurate coding of associated conditions such as hypoglycemia or hyperbilirubinemia.

Pediatrics

Documentation Requirements

Comprehensive follow-up notes detailing growth and development milestones.

Common Clinical Scenarios

Outpatient follow-up for growth assessment and developmental delays.

Billing Considerations

Consider the long-term implications of being light for gestational age on pediatric health.

Coding Guidelines

Inclusion Criteria

Use P05.01 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and birth weight
  • Use additional codes for any associated complications

Exclusion Criteria

Do NOT use P05.01 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 weighing less than 500 grams.

Documentation Requirements

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

Specialty Considerations

Neonatologists should ensure thorough documentation of the infant's condition.

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 low birth weight and 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 low birth weight and 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 low birth weight and associated complications.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Frequently Asked Questions

What are the key factors to consider when coding for P05.01?

Key factors include accurate documentation of birth weight, gestational age, and any maternal health issues that may have contributed to the infant's low weight. Additionally, be aware of any associated complications that may require co-coding.