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ICD-10 Guide
ICD-10 CodesP04.14

P04.14

Billable

Newborn affected by maternal use of opiates

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

Code Description

ICD-10 P04.14 is a billable code used to indicate a diagnosis of newborn affected by maternal use of opiates.

Key Diagnostic Point:

Newborns affected by maternal use of opiates may present with a range of symptoms due to in utero exposure to these substances. Maternal opiate use can lead to neonatal abstinence syndrome (NAS), characterized by withdrawal symptoms such as irritability, feeding difficulties, tremors, and seizures. These symptoms can manifest shortly after birth and may require specialized care in a neonatal intensive care unit (NICU). The impact of maternal opiate use extends beyond immediate withdrawal symptoms; it can also affect the newborn's growth, development, and long-term health outcomes. Clinicians must monitor these infants closely for potential complications, including respiratory distress, low birth weight, and developmental delays. Accurate coding of this condition is crucial for appropriate management and resource allocation in neonatal care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variability in withdrawal symptoms and severity among newborns
  • Need for comprehensive maternal history and substance use documentation
  • Potential for co-occurring conditions (e.g., prematurity, low birth weight)
  • Differentiation from other perinatal conditions (e.g., fetal alcohol syndrome)

Audit Risk Factors

  • Inadequate documentation of maternal substance use history
  • Failure to document withdrawal symptoms and treatment provided
  • Misclassification of severity of symptoms
  • Lack of follow-up documentation on infant outcomes

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal history, including type and duration of opiate use, and infant withdrawal symptoms.

Common Clinical Scenarios

Infants presenting with NAS in the NICU requiring pharmacological treatment and supportive care.

Billing Considerations

Consideration of the infant's gestational age and any co-existing conditions that may complicate treatment.

Pediatrics

Documentation Requirements

Ongoing assessment of developmental milestones and potential long-term effects of opiate exposure.

Common Clinical Scenarios

Follow-up visits for infants with a history of NAS to monitor growth and development.

Billing Considerations

Awareness of the psychosocial factors affecting the family and the need for multidisciplinary support.

Coding Guidelines

Inclusion Criteria

Use P04.14 When
  • Follow the official ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of maternal substance use and infant symptoms
  • Utilize additional codes as necessary to capture co
  • existing conditions

Exclusion Criteria

Do NOT use P04.14 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 for initial assessment of a newborn affected by maternal opiate use.

Documentation Requirements

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

Specialty Considerations

Neonatologists should ensure thorough documentation of withdrawal symptoms and treatment plans.

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 NAS and other drug-related newborn conditions. 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 NAS and other drug-related newborn conditions. 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 NAS and other drug-related newborn conditions. This specificity aids in research and resource allocation.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Abstinence Syndrome

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Abstinence Syndrome

Frequently Asked Questions

What are the common symptoms of NAS in newborns?

Common symptoms of NAS include irritability, feeding difficulties, tremors, seizures, and respiratory distress. These symptoms typically appear within 24-72 hours after birth and require careful monitoring and management.