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ICD-10 Guide
ICD-10 CodesP05.03

P05.03

Billable

Newborn light for gestational age, 750-999 grams

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

Code Description

ICD-10 P05.03 is a billable code used to indicate a diagnosis of newborn light for gestational age, 750-999 grams.

Key Diagnostic Point:

P05.03 refers to newborns who are classified as light for gestational age (LGA) and weigh between 750 and 999 grams at birth. This condition is often associated with various maternal factors such as inadequate prenatal care, maternal smoking, substance abuse, or underlying maternal health issues like hypertension or diabetes. Delivery complications, including preterm labor or placental insufficiency, can also contribute to low birth weight. Newborns in this weight 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: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various weight categories and gestational ages
  • Understanding maternal health factors impacting newborn weight
  • Identifying associated delivery complications
  • Navigating documentation requirements for NICU care

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to specify gestational age
  • Misclassification of birth weight categories
  • Lack of clarity in delivery complications

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, IV nutrition, or temperature regulation in the NICU.

Billing Considerations

Ensure accurate tracking of growth parameters and developmental milestones.

Pediatrics

Documentation Requirements

Comprehensive follow-up notes detailing growth and developmental assessments.

Common Clinical Scenarios

Pediatric visits for growth monitoring and developmental evaluations of infants with perinatal origins.

Billing Considerations

Consider the long-term implications of low birth weight on health outcomes.

Coding Guidelines

Inclusion Criteria

Use P05.03 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and birth weight
  • Utilize additional codes for any associated conditions or complications

Exclusion Criteria

Do NOT use P05.03 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 infant

Clinical Scenario

Used for initial assessments of newborns in the NICU.

Documentation Requirements

Document weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure comprehensive evaluations are recorded.

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 low birth weight infants effectively.

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 low birth weight infants effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage low birth weight infants effectively.

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 implications of coding P05.03?

Coding P05.03 indicates that the newborn is at risk for various health complications due to low birth weight. Accurate coding ensures appropriate care and resource allocation in the NICU.