Is P08.1 a billable ICD-10-CM code?

Yes. P08.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does P08.1 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).

What cannot be coded together with P08.1?

P08.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

P08.1

P08.1 — Other heavy for gestational age newborn

Billable / specific codeICD-10-CM

P08.1 is a billable, specific ICD-10-CM code for other heavy for gestational age newborn. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

newborn with a birth weight of 4500 or more (P08.0)
syndrome of infant of diabetic mother (P70.1)
syndrome of infant of mother with gestational diabetes (P70.0)

Inclusion terms

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

Other newborn heavy- or large-for-dates regardless of period of gestation
Usually implies a birth weight of 4000 g. to 4499 g.

Risk adjustment

P08.1 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.

How P08.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to P08.1.

Heavy-for-dates NEC(infant) (4000g to 4499g)
Large-for-dates NEC(infant) (4000g to 4499g)
Large›baby(regardless of gestational age) (4000g to 4499g)
Birth›weight›4000 grams to 4499 grams

Related codes at this level

Codes that share P08. If P08.1 is not quite right, the correct code is usually one of these.

Questions about P08.1

Is P08.1 a billable ICD-10-CM code?: Yes. P08.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does P08.1 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).
What cannot be coded together with P08.1?: P08.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.