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ICD-10 Guide
ICD-10 CodesP07.02

P07.02

Billable

Extremely low birth weight newborn, 500-749 grams

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

Code Description

ICD-10 P07.02 is a billable code used to indicate a diagnosis of extremely low birth weight newborn, 500-749 grams.

Key Diagnostic Point:

P07.02 refers to newborns classified as extremely low birth weight (ELBW), weighing between 500 and 749 grams at birth. These infants are at a significantly higher risk for various complications due to their low birth weight, including respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. The management of ELBW infants often requires specialized neonatal intensive care, including thermal regulation, respiratory support, and nutritional interventions. Maternal factors such as preterm labor, gestational diabetes, and hypertension can contribute to the risk of delivering an ELBW infant. Delivery complications, including placental abruption or previa, can also play a critical role in the outcomes for these newborns. Accurate coding of P07.02 is essential for tracking outcomes and resource utilization in neonatal care, as well as for appropriate reimbursement and quality reporting.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in clinical presentation and associated conditions
  • Need for detailed maternal history and delivery complications
  • Potential for multiple co-morbidities requiring additional coding
  • Documentation requirements for NICU care and interventions

Audit Risk Factors

  • Inadequate documentation of birth weight and gestational age
  • Failure to capture associated conditions or complications
  • Misclassification of birth weight categories
  • Lack of clarity in maternal health history

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

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

Common Clinical Scenarios

Management of ELBW infants in NICU, including respiratory support, feeding challenges, and monitoring for complications.

Billing Considerations

Ensure accurate tracking of growth and development milestones, as well as interventions specific to ELBW infants.

Pediatrics

Documentation Requirements

Comprehensive follow-up documentation that includes growth parameters and developmental assessments.

Common Clinical Scenarios

Pediatric evaluations of ELBW infants transitioning from NICU to outpatient care.

Billing Considerations

Consider the long-term implications of ELBW on health outcomes and developmental delays.

Coding Guidelines

Inclusion Criteria

Use P07.02 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of birth weight, gestational age, and any associated conditions
  • Use additional codes to capture complications and co
  • morbidities as necessary

Exclusion Criteria

Do NOT use P07.02 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 ELBW infants in the NICU.

Documentation Requirements

Document birth weight, gestational age, and any immediate complications.

Specialty Considerations

Neonatologists should ensure thorough documentation of the infant's condition and interventions.

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, including the ability to capture the nuances of extremely low birth weight infants. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including the ability to capture the nuances of extremely low birth weight infants. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including the ability to capture the nuances of extremely low birth weight infants. This specificity aids in better tracking of outcomes and resource utilization in neonatal care.

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 consider when coding for an ELBW infant?

When coding for an ELBW infant, it is crucial to document the exact birth weight, gestational age, and any maternal factors or delivery complications that may have contributed to the infant's condition. Additionally, capturing any associated conditions or complications is essential for accurate coding and reimbursement.