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ICD-10/Z05.42

Z05.42 ICD-10-CM Code: Observation and evaluation of newborn for suspected metabolic condition ruled out

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 795 — NORMAL NEWBORN (MDC 15)
  • MS-DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Observation and evaluation of newborn for suspected metabolic condition ruled out is a billable ICD-10-CM diagnosis code (Z05.42).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for Z05.42 in the official ICD-10-CM tabular list.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Observation and evaluation of newborn for suspected metabolic condition ruled out
    FY2017 changes

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as a perinatal/newborn (age 0 only) diagnosis; other ages are presumed incorrect.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of Z05.42 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • Z00-Z99 — Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99) (Z00-Z99) [Hierarchy]
  • Z00-Z13 — Persons encountering health services for examinations [Hierarchy]

Referenced by Excludes1 notes

  • Z03 — Encounter for medical observation for suspected diseases and conditions ruled out [Excludes1](via Z05.-): “encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together

Referenced by Excludes2 notes

  • P00 — Newborn affected by maternal conditions that may be unrelated to present pregnancy [Excludes2](via Z05.-): “encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together
  • P01 — Newborn affected by maternal complications of pregnancy [Excludes2](via Z05.-): “encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together
  • P02 — Newborn affected by complications of placenta, cord and membranes [Excludes2](via Z05.-): “encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together
  • P03 — Newborn affected by other complications of labor and delivery [Excludes2](via Z05.-): “encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together
  • P04 — Newborn affected by noxious substances transmitted via placenta or breast milk [Excludes2](via Z05.-): “encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)” · check together

Clinical classification (CCSR)

  • FAC003 — Encounter for observation and examination for conditions ruled out (excludes infectious disease, neoplasm, mental disorders) [CCSR]

Potential MS-DRG

  • DRG 795 — NORMAL NEWBORN [MS-DRG]: “NORMAL NEWBORN (MDC 15)”
  • DRG 951 — OTHER FACTORS INFLUENCING HEALTH STATUS [MS-DRG]: “OTHER FACTORS INFLUENCING HEALTH STATUS (MDC 23)”

MDC crossing · procedures (1235)

  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period [MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 23 — Factors Influencing Health Status and Other Contacts with Health Services [MDC crossing]: “Factors Influencing Health Status and Other Contacts with Health Services — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • and 1235 more

Index entries

  • Observation (following) (for) (without need for further medical care), newborn (for), suspected condition, related to exposure from the mother or birth process, ruled out, metabolic[Index term]

Nearest codes (18)

  • Z05 — Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out [Sibling]
  • Z05.0 — Observation and evaluation of newborn for suspected cardiac condition ruled out [Sibling]
  • Z05.1 — Observation and evaluation of newborn for suspected infectious condition ruled out [Sibling]
  • Z05.2 — Observation and evaluation of newborn for suspected neurological condition ruled out [Sibling]
  • Z05.3 — Observation and evaluation of newborn for suspected respiratory condition ruled out [Sibling]
  • Z05.4 — Observation and evaluation of newborn for suspected genetic, metabolic or immunologic condition ruled out [Sibling]
  • Z05.41 — Observation and evaluation of newborn for suspected genetic condition ruled out [Sibling]
  • Z05.43 — Observation and evaluation of newborn for suspected immunologic condition ruled out [Sibling]
  • and 10 more

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):FAC003 — Encounter for observation and examination for conditions ruled out (excludes infectious disease, neoplasm, mental disorders) (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 2 MS-DRGs: DRG 795 (MDC 15), DRG 951 (MDC 23).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name Z05.42 or its code family.

1 Excludes1 notes: Z03 (via Z05.-).

5 Excludes2 notes: P00 (via Z05.-), P01 (via Z05.-), P02 (via Z05.-), P03 (via Z05.-), P04 (via Z05.-).

Nearest Codes in This Family

Official ICD-10-CM classifications closest to Z05.42 in its code family, with their registry titles.

  • Z05.1 — Observation and evaluation of newborn for suspected infectious condition ruled out
  • Z05.2 — Observation and evaluation of newborn for suspected neurological condition ruled out
  • Z05.3 — Observation and evaluation of newborn for suspected respiratory condition ruled out
  • Z05.4 — Observation and evaluation of newborn for suspected genetic, metabolic or immunologic condition ruled out
  • Z05.41 — Observation and evaluation of newborn for suspected genetic condition ruled out
  • Z05.43 — Observation and evaluation of newborn for suspected immunologic condition ruled out
  • Z05.5 — Observation and evaluation of newborn for suspected gastrointestinal condition ruled out
  • Z05.6 — Observation and evaluation of newborn for suspected genitourinary condition ruled out
  • Z05.7 — Observation and evaluation of newborn for suspected skin, subcutaneous, musculoskeletal and connective tissue condition ruled out
  • Z05.71 — Observation and evaluation of newborn for suspected skin and subcutaneous tissue condition ruled out

View all codes in the Z05 family

Indexed Clinical Terms (1)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Observation (following) (for) (without need for further medical care), newborn (for), suspected condition, related to exposure from the mother or birth process, ruled out, metabolic