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ICD-10 Guide
ICD-10 CodesP05.04

P05.04

Billable

Newborn light for gestational age, 1000-1249 grams

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

Code Description

ICD-10 P05.04 is a billable code used to indicate a diagnosis of newborn light for gestational age, 1000-1249 grams.

Key Diagnostic Point:

P05.04 refers to newborns who are classified as light for gestational age (LGA) and weigh between 1000 to 1249 grams. This condition is often associated with various maternal factors such as inadequate prenatal care, maternal smoking, substance abuse, and chronic health issues like hypertension or diabetes. Delivery complications, including preterm labor and 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. These infants often require specialized care in a Neonatal Intensive Care Unit (NICU) to monitor their growth and development closely, as well as to manage any complications that arise. The clinical 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

  • Variability in maternal health conditions affecting birth weight
  • Need for detailed documentation of gestational age and weight
  • Potential for multiple co-morbidities in low birth weight infants
  • Differentiation from other weight categories (e.g., very low birth weight)

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to document delivery complications
  • Misclassification of birth weight categories
  • Lack of follow-up documentation on the infant's condition

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

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

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including growth charts and developmental screenings.

Common Clinical Scenarios

Follow-up visits for growth monitoring and management of feeding difficulties.

Billing Considerations

Consideration of long-term developmental outcomes and potential referrals to specialists.

Coding Guidelines

Inclusion Criteria

Use P05.04 When
  • Coders should adhere to the official ICD
  • CM guidelines, ensuring that the diagnosis is supported by clinical documentation
  • Accurate gestational age and weight must be recorded, and any associated conditions should be coded appropriately

Exclusion Criteria

Do NOT use P05.04 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 newborn weighing 1100 grams in the NICU.

Documentation Requirements

Documentation of the newborn's weight, gestational age, and any immediate care provided.

Specialty Considerations

Neonatologists should ensure comprehensive assessments are documented.

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. This specificity aids in research and quality improvement initiatives.

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. This specificity aids in research and quality improvement initiatives.

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. This specificity aids in research and quality improvement initiatives.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Care

Frequently Asked Questions

What are the key factors to document for coding P05.04?

Key factors include the newborn's weight, gestational age, maternal health history, and any delivery complications. Accurate documentation is crucial for supporting the diagnosis and ensuring appropriate care.