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ICD-10 Guide
ICD-10 CodesP04.12

P04.12

Billable

Newborn affected by maternal cytotoxic drugs

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

Code Description

ICD-10 P04.12 is a billable code used to indicate a diagnosis of newborn affected by maternal cytotoxic drugs.

Key Diagnostic Point:

Newborns affected by maternal cytotoxic drugs represent a significant concern in perinatal medicine. These drugs, which include chemotherapeutic agents and other noxious substances, can cross the placenta and affect fetal development, leading to a range of complications. Infants exposed to these substances may present with withdrawal symptoms, growth restrictions, and various organ dysfunctions. The effects can vary based on the timing of exposure during pregnancy, the type of drug, and the dosage. Common clinical manifestations include respiratory distress, feeding difficulties, and neurological impairments. Additionally, maternal use of substances such as alcohol, tobacco, and illicit drugs can further complicate the clinical picture, necessitating a comprehensive assessment and management plan for the affected newborn. Accurate coding is essential for tracking these cases and ensuring appropriate care and resources are allocated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal drug use and its effects on the newborn
  • Need for detailed maternal history to determine exposure
  • Differentiation between effects of various substances
  • Potential for co-occurring conditions requiring additional coding

Audit Risk Factors

  • Inadequate documentation of maternal drug history
  • Failure to document specific symptoms in the newborn
  • Misclassification of the type of drug exposure
  • Omission of co-occurring conditions

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of maternal drug use, newborn symptoms, and treatment plans.

Common Clinical Scenarios

Newborns in the NICU exhibiting withdrawal symptoms or requiring specialized care due to drug exposure.

Billing Considerations

Consideration of the timing of drug exposure and potential long-term effects on development.

Pediatrics

Documentation Requirements

Comprehensive pediatric assessments including developmental milestones and follow-up care plans.

Common Clinical Scenarios

Pediatric evaluations of children with histories of maternal drug exposure and associated complications.

Billing Considerations

Monitoring for developmental delays and behavioral issues stemming from prenatal exposure.

Coding Guidelines

Inclusion Criteria

Use P04.12 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of maternal drug use and the newborn's clinical presentation
  • Specific criteria for coding should include the type of drug, timing of exposure, and any associated complications

Exclusion Criteria

Do NOT use P04.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

Used for newborns requiring evaluation and management due to maternal drug exposure.

Documentation Requirements

Document maternal history, newborn assessment, and any interventions performed.

Specialty Considerations

Neonatologists should ensure thorough documentation of the newborn's clinical status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage cases of newborns affected by maternal drug use. This specificity aids in research and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage cases of newborns affected by maternal drug use. This specificity aids in research and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track and manage cases of newborns affected by maternal drug use. This specificity aids in research and resource allocation.

Resources

Clinical References

  • •
    CDC Guidelines on Maternal Substance Use

Coding & Billing References

  • •
    CDC Guidelines on Maternal Substance Use

Frequently Asked Questions

What are the common symptoms of newborns affected by maternal cytotoxic drugs?

Common symptoms include respiratory distress, feeding difficulties, jitteriness, and withdrawal symptoms. Each case may vary based on the specific drug and timing of exposure.