Wiki Low birth weight code being denied

[tvillarino]

I have a patient that was born prematurely and was coming in for weight checks to monitor growth. The physician is still using the P07.10 code even though the patient is gaining weight because they are still below normal. The patient is now 3 months old and we are getting denied for inappropriate age. The guidelines say that the code can be used in a child or an adult as long as the condition is affecting the patient's health status.

Is this the appropriate code to use or does any one have any guidance on this situation?

 

[vanrex]

This exact issue has recently bubbled up for me and my staff as well. All payers are denying for this reason when the documentation appears to support the assignment of codes P07.1- and P07.3-. Mine and my coding manager's interpretation is such that we agree with the guidelines but question if at the 29th day the condition should be described differently since these specific codes describe "newborn" low birth weight. So, when is the child not considered a newborn? I thought that was at the 29th day. Yes? No? Thoughts? Maybe we educate the payers??? That's the direction we're leaning in.