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v1.0.0
ICD-10 Guide
ICD-10 CodesP04.19

P04.19

Billable

Newborn affected by maternal use of unspecified medication

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

Code Description

ICD-10 P04.19 is a billable code used to indicate a diagnosis of newborn affected by maternal use of unspecified medication.

Key Diagnostic Point:

P04.19 refers to newborns who are affected by maternal use of unspecified medications, which can include a range of substances such as drugs, alcohol, and tobacco that are transmitted through the placenta or breast milk. Maternal substance use can lead to various complications in newborns, including withdrawal symptoms, developmental delays, and other health issues. The impact of these substances can vary widely depending on the type and amount of substance used, as well as the timing of exposure during pregnancy. Common effects may include low birth weight, respiratory distress, and neurological impairments. It is crucial for healthcare providers to document maternal substance use accurately to ensure appropriate care and management of the newborn. This code is essential for capturing the complexities of maternal health behaviors and their direct impact on neonatal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of substances that can affect the newborn
  • Need for detailed maternal history and documentation
  • Potential for overlapping symptoms with other conditions
  • Variability in clinical presentation based on substance type

Audit Risk Factors

  • Inadequate documentation of maternal substance use
  • Failure to specify the type of medication or substance
  • Misclassification of symptoms related to substance exposure
  • Lack of interdisciplinary notes on maternal health

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal history, including substance use, prenatal care records, and newborn assessment findings.

Common Clinical Scenarios

Newborns presenting with withdrawal symptoms, respiratory distress, or developmental delays due to maternal substance use.

Billing Considerations

Consider the timing of substance exposure and its potential effects on neonatal health; ensure thorough documentation of all findings.

Pediatrics

Documentation Requirements

Comprehensive pediatric evaluations that include maternal history and any observed effects on the newborn.

Common Clinical Scenarios

Pediatric follow-ups for newborns with developmental concerns linked to maternal substance use.

Billing Considerations

Monitor for long-term developmental outcomes and ensure continuity of care with appropriate referrals.

Coding Guidelines

Inclusion Criteria

Use P04.19 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that all relevant maternal and neonatal documentation is included to support the use of P04
  • Accurate coding requires a clear understanding of the maternal history and the clinical presentation of the newborn

Exclusion Criteria

Do NOT use P04.19 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 newborns affected by maternal substance use requiring initial evaluation.

Documentation Requirements

Document maternal history, newborn assessment, and any interventions.

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 maternal substance use, improving the ability to track and manage neonatal outcomes related to maternal health behaviors.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal substance use, improving the ability to track and manage neonatal outcomes related to maternal health behaviors.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    CDC Guidelines on Maternal Substance Use

Coding & Billing References

  • •
    CDC Guidelines on Maternal Substance Use

Frequently Asked Questions

What documentation is required for coding P04.19?

Documentation should include a detailed maternal history of substance use, any observed effects on the newborn, and a comprehensive assessment of the newborn's health status.