2025 ICD-10-CM code Z05.3
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Observation and evaluation of newborn Chapter 21: Factors Influencing Health Status and Contact with Health Services Feed
Observation and evaluation of a newborn for a suspected respiratory condition that was ruled out.
Medical necessity is established when there is a clinical suspicion of a respiratory condition in a newborn, requiring a comprehensive evaluation to rule out the possibility of a serious respiratory disease. The evaluation is medically necessary to ensure the infant receives timely and appropriate care.
The clinical responsibility lies with the physician or healthcare professional who performs the examination and evaluation of the newborn to rule out the suspected respiratory condition. This may include reviewing the patient's history, performing a physical examination, and ordering appropriate investigations such as blood tests, chest X-rays, or other diagnostic procedures.
- Chapter 21: Factors Influencing Health Status and Contact with Health Services
- Z00-Z13 (Persons encountering health services for examinations)
In simple words: The baby was checked by the doctor because there was a concern about a possible breathing problem. After the exam and tests, the doctor found that the baby did not have any breathing problems.
This code (Z05.3) is used to classify an encounter for the observation and evaluation of a newborn infant where a respiratory condition was suspected but ultimately ruled out after examination and testing.The code indicates that the reason for the encounter was to assess the infant's respiratory status, and that no respiratory condition was diagnosed.
Example 1: A newborn is admitted to the hospital exhibiting some signs and symptoms that suggest a potential respiratory issue. After comprehensive evaluation (including chest X-ray and blood gas analysis) the respiratory condition is ruled out.Code Z05.3 is used to reflect the reason for the encounter., A mother brings her newborn for a well-baby check-up. During the visit, the physician notes some slight irregularities in the baby's breathing pattern and decides to conduct a thorough assessment to exclude any underlying respiratory problem. After the evaluation, it's determined there is no respiratory issue. Code Z05.3 is assigned., A newborn in the neonatal intensive care unit (NICU) exhibits subtle signs of respiratory distress.A complete workup is performed.The evaluation ultimately shows that the symptoms were transient and not indicative of a significant respiratory illness. Code Z05.3 is applied.
Detailed documentation should include the reason for suspicion of a respiratory condition, the results of all examinations and investigations (e.g., physical examination findings, respiratory rate, oxygen saturation, chest x-ray reports, blood gas results), and the physician's determination that a respiratory condition was ruled out.The documentation must clearly support the use of code Z05.3.
** This code should only be used when a respiratory condition was suspected but not confirmed. If a respiratory condition is diagnosed, the appropriate code for that condition should be used instead of Z05.3.If multiple encounters occur on the same day and the medical records are combined, the appropriate code reflecting the overall encounter would be selected.
- Payment Status: Active
- Specialties:Neonatology, Pediatrics
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office