Is P05.1 a billable ICD-10-CM code?

No. P05.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does P05.1 sit in the tabular list?

Certain conditions originating in the perinatal period (P00-P96), in the block Disorders of newborn related to length of gestation and fetal growth (P05-P08).

P05.1

P05.1 — Newborn small for gestational age

Non-billable headerICD-10-CM

P05.1 is a non-billable header ICD-10-CM code for newborn small for gestational age. It cannot be billed on its own: choose one of the more specific child codes below.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Newborn small-and-light-for-dates
Newborn small-for-dates
Weight and length below 10th percentile for gestational age

Other codes that can never be billed with P05.1

These codes carry an Excludes1 note pointing at P05.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P05.1 alone.

P05.2Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age

Risk adjustment

P05.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead P05.1

10 child codes. Green means billable.

Related codes at this level

Codes that share P05. If P05.1 is not quite right, the correct code is usually one of these.

Questions about P05.1

Is P05.1 a billable ICD-10-CM code?: No. P05.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does P05.1 sit in the tabular list?: Certain conditions originating in the perinatal period (P00-P96), in the block Disorders of newborn related to length of gestation and fetal growth (P05-P08).