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ICD-10 Guide
ICD-10 CodesP07.16

P07.16

Billable

Other low birth weight newborn, 1500-1749 grams

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

Code Description

ICD-10 P07.16 is a billable code used to indicate a diagnosis of other low birth weight newborn, 1500-1749 grams.

Key Diagnostic Point:

P07.16 refers to newborns with a birth weight classified as low, specifically those weighing between 1500 and 1749 grams. This category encompasses a range of clinical scenarios often linked to maternal factors such as preeclampsia, gestational diabetes, or inadequate prenatal care, as well as delivery complications like preterm labor or placental insufficiency. Newborns in this weight range are at increased risk for various health issues, including respiratory distress syndrome, feeding difficulties, and temperature regulation problems. They may require specialized care in a Neonatal Intensive Care Unit (NICU) to monitor their growth and development closely. The management of these infants often involves a multidisciplinary approach, including neonatologists, nurses, and lactation consultants, to address their unique needs and ensure optimal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation among low birth weight infants.
  • Need for detailed maternal history to identify contributing factors.
  • Potential for multiple coexisting conditions requiring additional coding.
  • Documentation requirements for NICU admissions and ongoing care.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to capture all relevant coexisting conditions.
  • Misclassification of birth weight categories.
  • Lack of clarity in discharge summaries regarding ongoing care needs.

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 phototherapy for jaundice.

Billing Considerations

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

Pediatrics

Documentation Requirements

Comprehensive follow-up notes detailing growth, feeding, and developmental assessments.

Common Clinical Scenarios

Pediatric visits for growth monitoring and management of chronic conditions stemming from low birth weight.

Billing Considerations

Consideration of long-term outcomes and potential developmental delays in follow-up care.

Coding Guidelines

Inclusion Criteria

Use P07.16 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of birth weight, gestational age, and any maternal factors that may contribute to low birth weight

Exclusion Criteria

Do NOT use P07.16 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 infant

Clinical Scenario

Used for initial assessment of a low birth weight infant in the NICU.

Documentation Requirements

Document birth weight, gestational age, and any immediate care provided.

Specialty Considerations

Neonatologists should ensure comprehensive 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 low birth weight categories, improving the ability to track and manage these conditions effectively. It has also enhanced the granularity of data for research and quality improvement initiatives in neonatal care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of low birth weight categories, improving the ability to track and manage these conditions effectively. It has also enhanced the granularity of data for research and quality improvement initiatives in neonatal care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of low birth weight categories, improving the ability to track and manage these conditions effectively. It has also enhanced the granularity of data for research and quality improvement initiatives in neonatal care.

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 are the implications of coding P07.16 for reimbursement?

Coding P07.16 accurately is crucial for reimbursement as it reflects the complexity of care required for low birth weight infants. Proper documentation of associated conditions and care provided will support claims and reduce the risk of audits.