2025 ICD-10-CM code Z05.1
Encounter for observation and evaluation of newborn for suspected infectious condition ruled out.
Medical necessity for this code is established when a newborn presents with a reasonable suspicion of an infectious condition based on risk factors or clinical presentation. The evaluation and observation are necessary to rule out the suspected condition and ensure the newborn's well-being.
The physician is responsible for observing and evaluating the newborn for the suspected infectious condition, performing any necessary tests, and documenting the findings that led to the condition being ruled out.
- Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
- Z05: Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out
In simple words: This code is used when a newborn baby is checked for a suspected infection, but after observation and tests, the infection is ruled out.
This code is used for newborns within the first 28 days of life who are suspected of having an infectious condition, but without signs or symptoms, and which, after examination and observation, is ruled out.
Example 1: A newborn is observed for potential neonatal sepsis due to maternal group B streptococcus (GBS) colonization. After observation and negative blood cultures, sepsis is ruled out., A newborn born to a mother with a urinary tract infection is monitored for signs of infection. Following a period of observation and normal lab results, the suspected infection is ruled out., A newborn with a family history of congenital herpes is observed for signs of the infection. After examination and negative testing, the infection is ruled out.
Documentation should include details of the suspected infectious condition, the mother's medical history (if relevant), the newborn's vital signs and examination findings, results of any laboratory or diagnostic tests performed, and the rationale for ruling out the suspected condition.
** This code is exempt from the Present on Admission (POA) reporting requirement.
- Place of Service:Inpatient Hospital