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ICD-10 Guide
ICD-10 CodesChapter 16: Certain conditions originating in the perinatal periodP07

P07

Billable

Disorders of newborn related to short gestation and low birth weight, not elsewhere classified

Chapter 16:Certain conditions originating in the perinatal period

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

Code Description

ICD-10 P07 is a billable code used to indicate a diagnosis of disorders of newborn related to short gestation and low birth weight, not elsewhere classified.

Key Diagnostic Point:

Disorders classified under P07 encompass a range of conditions affecting newborns who are born preterm or with low birth weight, which are often linked to maternal factors such as inadequate prenatal care, maternal health issues, or complications during delivery. These disorders can manifest as respiratory distress syndrome, feeding difficulties, and increased susceptibility to infections. Newborns with low birth weight may also experience thermoregulation issues and developmental delays. The clinical management of these infants often requires specialized neonatal care, including monitoring in a NICU setting, nutritional support, and interventions to address any immediate health concerns. Understanding the underlying maternal factors and delivery complications is crucial for accurate coding and effective treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of low birth weight and preterm infants
  • Need for detailed maternal history to determine causative factors
  • Differentiation from other neonatal conditions with similar presentations
  • Documentation of gestational age and birth weight

Audit Risk Factors

  • Inadequate documentation of gestational age and birth weight
  • Failure to link maternal factors to newborn conditions
  • Misclassification of conditions due to overlapping symptoms
  • Lack of clarity in the clinical narrative

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of gestational age, birth weight, and any complications during delivery are essential. Neonatal assessments and interventions must be documented thoroughly.

Common Clinical Scenarios

Common scenarios include a preterm infant requiring respiratory support or a low birth weight infant needing specialized feeding protocols.

Billing Considerations

Neonatologists must ensure that all maternal health factors are documented to support the coding of P07.

Pediatrics

Documentation Requirements

Pediatricians should document any ongoing developmental assessments and follow-up care for infants with low birth weight or preterm birth.

Common Clinical Scenarios

Pediatric scenarios may include monitoring for growth and developmental milestones in a child with a history of low birth weight.

Billing Considerations

Pediatricians should be aware of the long-term implications of low birth weight on health outcomes.

Coding Guidelines

Inclusion Criteria

Use P07 When
  • Coders should adhere to official ICD
  • 10 guidelines, ensuring accurate documentation of gestational age and birth weight
  • It is important to use additional codes to specify any associated conditions or complications

Exclusion Criteria

Do NOT use P07 When
No specific exclusions found.

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 low birth weight infants in the NICU.

Documentation Requirements

Documentation must include gestational age, birth weight, and any complications.

Specialty Considerations

Neonatologists should ensure that all assessments are detailed to support the coding.

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 preterm birth, which can lead to 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 low birth weight and preterm birth, which can lead to better tracking of outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Coding in Neonatology

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Coding in Neonatology

Frequently Asked Questions

What documentation is required for coding P07?

Documentation must include the newborn's gestational age, birth weight, and any maternal factors that may have contributed to the condition. Detailed clinical notes regarding the infant's health status and any interventions provided are also necessary.