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  6. 2026 ICD-10-CM Code Z05.1

2026 ICD-10-CM Diagnosis Code Z05.1

Observation and evaluation of newborn for suspected infectious condition ruled out

ICD-10-CM Code:
Z05.1
ICD-10 Code for:
Obs & eval of NB for suspected infect condition ruled out
Is Billable?
Yes - Valid for Submission
Code Navigator:

Z05.1 is a billable diagnosis code used to specify a medical diagnosis of observation and evaluation of newborn for suspected infectious condition ruled out. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2025 through September 30, 2026. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z05.1 is applicable to newborn patients only. It is clinically and virtually impossible to use this code on a non-newborn patient.

Code Classification

  • Factors influencing health status and contact with health services
    Z00–Z99
    • Persons encountering health services for examinations
      Z00-Z13
      • Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out
        Z05

Clinical Classification

Clinical Classifications group individual ICD-10-CM diagnosis codes into broader, clinically meaningful categories. These categories help simplify complex data by organizing related conditions under common clinical themes.

They are especially useful for data analysis, reporting, and clinical decision-making. Even when diagnosis codes differ, similar conditions can be grouped together based on their clinical relevance. Each category is assigned a unique CCSR code that represents a specific clinical concept, often tied to a body system or medical specialty.

Exposure, encounters, screening or contact with infectious disease

CCSR Code: FAC016

Inpatient Default: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.

Outpatient Default: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

Index of External Cause of Injuries

References found for this diagnosis code in the External Cause of Injuries Index:

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

Code Edits

The Medicare Code Editor (MCE) detects errors and inconsistencies in ICD-10-CM diagnosis coding that can affect Medicare claim validity. These Medicare code edits help medical coders and billing professionals determine when a diagnosis code is not appropriate as a principal diagnosis, does not meet coverage criteria. Use this list to verify whether a code is valid for Medicare billing and to avoid claim rejections or denials due to diagnosis coding issues.

Perinatal / Newborn diagnoses

The Medicare Code Editor detects inconsistencies in perinatal / newborn cases by checking a patient's age and any diagnosis on the patient's record. The newborn code edits apply to patients age 0 years only; a subset of diagnoses which will only occur during the perinatal or newborn period of age 0 (e.g., tetanus neonatorum, health examination for newborn under 8 days old).

View Edit

Present on Admission (POA)

Z05.1 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator: Y

Reason: Diagnosis was present at time of inpatient admission.

CMS Pays CC/MCC DRG? YES

POA Indicator: N

Reason: Diagnosis was not present at time of inpatient admission.

CMS Pays CC/MCC DRG? NO

POA Indicator: U

Reason: Documentation insufficient to determine if the condition was present at the time of inpatient admission.

CMS Pays CC/MCC DRG? NO

POA Indicator: W

Reason: Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.

CMS Pays CC/MCC DRG? YES

POA Indicator: 1

Reason: Unreported/Not used - Exempt from POA reporting.

CMS Pays CC/MCC DRG? NO

Replacement Code

Z051 replaces the following previously assigned ICD-10-CM code(s):

  • P00.2 - Newborn affected by maternal infec/parastc diseases

Convert Z05.1 to ICD-9-CM

Below are the ICD-9 codes that most closely match this ICD-10 code, based on the General Equivalence Mappings (GEMs). This ICD-10 to ICD-9 crosswalk tool is helpful for coders who need to reference legacy diagnosis codes for audits, historical claims, or approximate code comparisons.

NB obsrv suspct infect

ICD-9-CM: V29.0

Approximate Flag - The approximate mapping means this ICD-10 code does not have an exact ICD-9 equivalent. The matched code is the closest available option, but it may not fully capture the original diagnosis or clinical intent.

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Patient Education


Newborn Screening

Your newborn infant has screening tests before leaving the hospital. There may be different tests depending on the state where you live. They include:

  • Tests on a few drops of blood from pricking the baby's heel. The tests look for inherited disorders. All states test for at least 30 of these conditions.
  • A hearing test that measures the baby's response to sound
  • A skin test that measures the level of oxygen in the blood. This can tell if the baby has a congenital heart defect.

These tests look for serious medical conditions. If not treated, some of these conditions can cause lifelong health problems. Others can cause early death. With early diagnosis, treatment can begin right away, before serious problems can occur or become permanent.

If a screening shows that your baby might have a condition, the health care provider or the state health department will call you. It is important to follow up quickly. Further testing can verify whether your baby has the condition. If so, treatment should start right away.

NIH: National Institute of Child Health and Human Development


[Learn More in MedlinePlus]

Code History

  • FY 2026 - No Change, effective from 10/1/2025 through 9/30/2026
  • FY 2025 - No Change, effective from 10/1/2024 through 9/30/2025
  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018