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ICD-10 Guide
ICD-10 CodesP04.13

P04.13

Billable

Newborn affected by maternal use of anticonvulsants

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

Code Description

ICD-10 P04.13 is a billable code used to indicate a diagnosis of newborn affected by maternal use of anticonvulsants.

Key Diagnostic Point:

P04.13 refers to newborns who are affected by the maternal use of anticonvulsants during pregnancy. These medications, while essential for managing maternal seizure disorders, can lead to various complications in the neonate. Common effects include withdrawal symptoms, teratogenic effects, and potential neurodevelopmental issues. Newborns may present with symptoms such as irritability, feeding difficulties, and abnormal muscle tone. The timing and dosage of maternal medication, as well as the specific anticonvulsant used, can influence the severity of the newborn's condition. It is crucial for healthcare providers to monitor these infants closely for signs of withdrawal and other complications, and to provide appropriate interventions. Documentation should include maternal medication history, timing of exposure, and any observed neonatal symptoms to ensure accurate coding and care planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal medication regimens and their effects on the newborn.
  • Need for detailed maternal history to determine the timing and dosage of anticonvulsants.
  • Potential overlap with other substance exposure codes (e.g., alcohol, tobacco).
  • Documentation of withdrawal symptoms can be subjective and variable.

Audit Risk Factors

  • Inadequate documentation of maternal medication history.
  • Failure to document specific symptoms of withdrawal in the newborn.
  • Misclassification of the newborn's condition due to overlapping symptoms with other perinatal codes.
  • Lack of clarity on the timing of maternal drug use.

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of maternal medication use, timing of exposure, and neonatal assessment findings.

Common Clinical Scenarios

Neonates presenting with irritability, feeding difficulties, or seizures in the NICU.

Billing Considerations

Close monitoring for withdrawal symptoms and potential long-term developmental impacts.

Pediatrics

Documentation Requirements

Comprehensive history of maternal drug use and ongoing developmental assessments.

Common Clinical Scenarios

Follow-up visits for developmental milestones in children with a history of anticonvulsant exposure.

Billing Considerations

Consideration of potential neurodevelopmental delays and the need for early intervention services.

Coding Guidelines

Inclusion Criteria

Use P04.13 When
  • According to ICD
  • 10 coding guidelines, P04
  • 13 should be used when there is clear documentation of maternal anticonvulsant use and its effects on the newborn
  • Coders must ensure that all relevant maternal history and neonatal symptoms are documented to support the use of this code

Exclusion Criteria

Do NOT use P04.13 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 in conjunction with P04.13 for initial assessment of affected newborns.

Documentation Requirements

Documentation of maternal history and neonatal assessment findings.

Specialty Considerations

Neonatologists should ensure thorough documentation of the newborn's condition and maternal drug history.

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, including P04.13, which provides better data for tracking outcomes related to maternal drug use.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including P04.13, which provides better data for tracking outcomes related to maternal drug use.

Reimbursement & Billing Impact

reimbursement and quality reporting.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Coding & Billing References

  • •
    American Academy of Pediatrics - Guidelines for Perinatal Care

Frequently Asked Questions

What are the common symptoms in newborns affected by maternal anticonvulsant use?

Common symptoms include irritability, feeding difficulties, tremors, and abnormal muscle tone. These symptoms may vary based on the specific anticonvulsant used and the timing of exposure.