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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.02

P05.02

Billable

Newborn light for gestational age, 500-749 grams

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

Code Description

ICD-10 P05.02 is a billable code used to indicate a diagnosis of newborn light for gestational age, 500-749 grams.

Key Diagnostic Point:

P05.02 refers to newborns who are classified as light for gestational age, specifically those weighing between 500 and 749 grams at birth. This condition is often associated with various maternal factors such as inadequate prenatal care, maternal smoking, substance abuse, and chronic health conditions like hypertension or diabetes. Delivery complications, including preterm labor and 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, hypothermia, and feeding difficulties. They often require specialized care in a Neonatal Intensive Care Unit (NICU) to monitor their growth and development closely. The management of these infants involves a multidisciplinary approach, including neonatologists, nurses, and lactation consultants, to ensure optimal outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in gestational age and weight classifications
  • Need for detailed maternal history and delivery complications
  • Potential for multiple co-morbidities requiring additional coding
  • Documentation requirements for NICU care and interventions

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to specify gestational age accurately
  • Misclassification of birth weight categories
  • Omission of co-morbid conditions

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Infants requiring respiratory support, temperature regulation, and nutritional interventions in the NICU.

Billing Considerations

Accurate tracking of growth parameters and developmental milestones is crucial for ongoing care.

Pediatrics

Documentation Requirements

Comprehensive follow-up records detailing growth, developmental assessments, and any ongoing health issues.

Common Clinical Scenarios

Pediatric visits for monitoring growth and development in infants with perinatal origins.

Billing Considerations

Consideration of long-term outcomes and potential developmental delays in follow-up care.

Coding Guidelines

Inclusion Criteria

Use P05.02 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age, birth weight, and any associated maternal factors or delivery complications

Exclusion Criteria

Do NOT use P05.02 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 assessments of newborns in the NICU.

Documentation Requirements

Documentation of the newborn's condition, weight, and any interventions performed.

Specialty Considerations

Neonatologists must ensure detailed records of care provided.

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

impact care.

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 document for P05.02?

Key factors include the newborn's weight, gestational age, maternal health history, and any complications during delivery. Detailed documentation helps ensure accurate coding and appropriate care.