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v1.0.0
ICD-10 Guide
ICD-10 CodesP01.9

P01.9

Billable

Newborn affected by maternal complication of pregnancy, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 P01.9 is a billable code used to indicate a diagnosis of newborn affected by maternal complication of pregnancy, unspecified.

Key Diagnostic Point:

The code P01.9 is used to classify newborns who are affected by unspecified maternal complications during pregnancy. These complications can include conditions such as incompetent cervix, which may lead to premature birth, and premature rupture of membranes (PROM), which can increase the risk of infection and other complications for the newborn. Additionally, multiple pregnancies can complicate delivery and increase the likelihood of adverse outcomes for the newborn. The clinical implications of these maternal conditions can vary widely, affecting the newborn's health status, necessitating close monitoring and potential interventions in the neonatal intensive care unit (NICU). Accurate coding is essential for appropriate management and resource allocation in neonatal care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal complications and their effects on newborns
  • Need for detailed documentation to specify maternal conditions
  • Potential overlap with other neonatal codes
  • Variations in clinical presentation based on gestational age

Audit Risk Factors

  • Inadequate documentation of maternal complications
  • Failure to specify the impact of maternal conditions on the newborn
  • Misclassification of the newborn's condition
  • Inconsistent coding practices among healthcare providers

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Neonatal documentation must include detailed maternal history, specific complications, and their impact on the newborn's health.

Common Clinical Scenarios

Common scenarios include a newborn delivered preterm due to incompetent cervix or a newborn with signs of infection due to PROM.

Billing Considerations

Consideration must be given to the gestational age and any immediate interventions required for the newborn.

Pediatrics

Documentation Requirements

Pediatric documentation should reflect ongoing assessments of the newborn's health status and any developmental concerns stemming from maternal complications.

Common Clinical Scenarios

Pediatric scenarios may involve follow-up care for developmental delays or health issues related to multiple births.

Billing Considerations

Pediatricians should be aware of the long-term implications of maternal complications on child health.

Coding Guidelines

Inclusion Criteria

Use P01.9 When
  • According to ICD
  • 10 coding guidelines, P01
  • 9 should be used when the specific maternal complication is not documented
  • Coders should ensure that all relevant maternal history is captured to support the use of this code

Exclusion Criteria

Do NOT use P01.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, per day, for evaluation and management of a normal newborn

Clinical Scenario

Used when a newborn affected by maternal complications requires initial evaluation in the NICU.

Documentation Requirements

Documentation must include maternal history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure comprehensive evaluations are documented to support billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding of maternal complications, improving the specificity of newborn diagnoses and enhancing the ability to track outcomes related to maternal health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of maternal complications, improving the specificity of newborn diagnoses and enhancing the ability to track outcomes related to maternal health.

Reimbursement & Billing Impact

impact on the newborn's health, including any interventions required.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should I document to support the use of code P01.9?

To support the use of code P01.9, document the maternal complications clearly, including their impact on the newborn's health, gestational age at delivery, and any interventions required.