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ICD-10 Guide
ICD-10 CodesP05.16

P05.16

Billable

Newborn small for gestational age, 1500-1749 grams

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

Code Description

ICD-10 P05.16 is a billable code used to indicate a diagnosis of newborn small for gestational age, 1500-1749 grams.

Key Diagnostic Point:

Newborns classified as small for gestational age (SGA) are those whose birth weight is below the 10th percentile for their gestational age. Specifically, P05.16 refers to newborns weighing between 1500 and 1749 grams. This condition can arise due to various maternal factors such as inadequate maternal nutrition, placental insufficiency, or maternal health issues like hypertension or diabetes. Delivery complications, including preterm birth or intrauterine growth restriction (IUGR), can also contribute to SGA status. These infants are at increased risk for perinatal morbidity and mortality, necessitating close monitoring and potential interventions in the neonatal intensive care unit (NICU). Management may include thermal regulation, nutritional support, and monitoring for complications such as hypoglycemia or respiratory distress. Accurate coding is essential for appropriate reimbursement and to reflect the complexity of care provided.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in gestational age assessment
  • Differentiation between SGA and IUGR
  • Maternal health factors influencing fetal growth
  • Documentation of birth weight and gestational age

Audit Risk Factors

  • Inadequate documentation of maternal health history
  • Failure to specify gestational age accurately
  • Misclassification of SGA versus IUGR
  • Lack of follow-up documentation on infant's growth

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Infants admitted to the NICU for monitoring due to low birth weight and potential complications.

Billing Considerations

Ensure accurate tracking of growth parameters and any interventions provided.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including growth charts and developmental milestones.

Common Clinical Scenarios

Follow-up visits for SGA infants to monitor growth and development.

Billing Considerations

Consider the long-term implications of being SGA on pediatric health.

Coding Guidelines

Inclusion Criteria

Use P05.16 When
  • Follow the ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of gestational age and birth weight
  • Use additional codes to capture any associated conditions or complications

Exclusion Criteria

Do NOT use P05.16 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 SGA infants in the NICU.

Documentation Requirements

Document birth weight, gestational age, and any complications.

Specialty Considerations

Neonatologists should ensure thorough documentation of all assessments.

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 SGA and its associated risks. This specificity aids in better tracking of outcomes and resource allocation.

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 SGA and its associated risks. This specificity aids in better tracking of outcomes and resource allocation.

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 SGA and its associated risks. This specificity aids in better tracking of outcomes and resource allocation.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding and Billing

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding and Billing

Frequently Asked Questions

What factors contribute to a newborn being classified as SGA?

Factors include maternal health conditions (e.g., hypertension, diabetes), inadequate nutrition during pregnancy, placental insufficiency, and environmental factors such as smoking or substance abuse.