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v1.0.0
ICD-10 Guide
ICD-10 CodesP05.1

P05.1

Billable

Newborn small for gestational age

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

Code Description

ICD-10 P05.1 is a billable code used to indicate a diagnosis of newborn small for gestational age.

Key Diagnostic Point:

Newborn small for gestational age (SGA) refers to infants whose birth weight is below the 10th percentile for their gestational age. This condition can arise from various maternal factors, including inadequate maternal nutrition, placental insufficiency, and maternal health issues such as hypertension or diabetes. Delivery complications, such as preterm birth or intrauterine growth restriction (IUGR), can also contribute to SGA. Clinically, SGA infants may present with low birth weight, decreased subcutaneous fat, and potential respiratory distress. These infants are at increased risk for long-term developmental issues and require careful monitoring and management in the neonatal period. Accurate coding of SGA is crucial for appropriate resource allocation and management strategies in neonatal care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between SGA and other growth-related conditions such as IUGR.
  • Understanding maternal health factors that contribute to SGA.
  • Documenting the gestational age accurately to determine percentiles.
  • Identifying associated complications that may require additional coding.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to specify gestational age at delivery.
  • Misclassification of SGA versus IUGR.
  • Omission of associated complications in coding.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed birth weight, gestational age, and maternal health history.

Common Clinical Scenarios

NICU admissions for SGA infants requiring respiratory support or feeding interventions.

Billing Considerations

Monitoring for potential long-term developmental delays and ensuring follow-up care.

Pediatrics

Documentation Requirements

Growth charts and developmental assessments post-discharge.

Common Clinical Scenarios

Pediatric follow-ups for SGA infants to monitor growth and development.

Billing Considerations

Consideration of nutritional needs and developmental milestones.

Coding Guidelines

Inclusion Criteria

Use P05.1 When
  • Follow the official ICD
  • CM guidelines for coding SGA, ensuring accurate documentation of gestational age and associated maternal factors
  • Use additional codes for any complications or associated conditions

Exclusion Criteria

Do NOT use P05.1 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 SGA infants requiring initial evaluation in the nursery.

Documentation Requirements

Document birth weight, gestational age, and any complications.

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 SGA, improving the ability to track and manage this condition in newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of SGA, improving the ability to track and manage this condition in newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of SGA, improving the ability to track and manage this condition in newborns.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding Newborns

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding Newborns

Frequently Asked Questions

What factors contribute to a newborn being classified as SGA?

Factors include maternal health conditions, nutritional status, and placental function. Accurate documentation of these factors is essential for proper coding.