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ICD-10 Guide
ICD-10 CodesP04.17

P04.17

Billable

Newborn affected by maternal use of sedative-hypnotics

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

Code Description

ICD-10 P04.17 is a billable code used to indicate a diagnosis of newborn affected by maternal use of sedative-hypnotics.

Key Diagnostic Point:

P04.17 refers to newborns who are affected by the maternal use of sedative-hypnotics during pregnancy. This condition arises when substances such as benzodiazepines or barbiturates are used by the mother, leading to potential withdrawal symptoms or other complications in the newborn. The impact of sedative-hypnotics can manifest as respiratory depression, lethargy, feeding difficulties, and altered neurological status. The severity of symptoms can vary based on the timing and dosage of maternal drug use, as well as the specific substances involved. Newborns may require close monitoring in a neonatal intensive care unit (NICU) for signs of withdrawal or other complications. It is crucial for healthcare providers to document maternal substance use thoroughly, as this information is vital for appropriate management and coding. The condition underscores the importance of prenatal care and the need for healthcare providers to counsel expectant mothers about the risks associated with drug use during pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal drug use patterns and types of sedative-hypnotics
  • Differential diagnosis with other neonatal withdrawal syndromes
  • Need for comprehensive maternal history documentation
  • Potential for co-occurring conditions in the newborn

Audit Risk Factors

  • Inadequate documentation of maternal drug use
  • Failure to capture co-occurring conditions
  • Misclassification of withdrawal symptoms
  • Lack of follow-up documentation on newborn outcomes

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal history, including specific substances used, timing, and dosage.

Common Clinical Scenarios

Newborns presenting with lethargy, respiratory distress, or feeding difficulties in the NICU.

Billing Considerations

Monitoring for withdrawal symptoms and ensuring accurate coding based on clinical presentation.

Pediatrics

Documentation Requirements

Documentation of developmental assessments and follow-up care for affected newborns.

Common Clinical Scenarios

Pediatric evaluations of newborns with a history of maternal sedative-hypnotic use.

Billing Considerations

Consideration of long-term developmental impacts and the need for multidisciplinary follow-up.

Coding Guidelines

Inclusion Criteria

Use P04.17 When
  • According to ICD
  • 10 coding guidelines, P04
  • 17 should be used when there is clear documentation of maternal sedative
  • hypnotic use and its effects on the newborn
  • Coders should ensure that all relevant maternal history is captured to support the diagnosis

Exclusion Criteria

Do NOT use P04.17 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 sedative-hypnotics.

Documentation Requirements

Document maternal drug history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure comprehensive evaluations are performed.

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 P04.17, which enhances the ability to track and manage cases of newborns affected by maternal drug use more effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including P04.17, which enhances the ability to track and manage cases of newborns affected by maternal drug use more effectively.

Reimbursement & Billing Impact

reimbursement and quality care tracking.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Substance Use in Pregnancy

Coding & Billing References

  • •
    American Academy of Pediatrics - Substance Use in Pregnancy

Frequently Asked Questions

What are the common symptoms of a newborn affected by maternal sedative-hypnotics?

Common symptoms include lethargy, respiratory depression, feeding difficulties, and irritability. Monitoring in a NICU setting is often required for these newborns.