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ICD-10 Guide
ICD-10 CodesP04.40

P04.40

Billable

Newborn affected by maternal use of unspecified drugs of addiction

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

Code Description

ICD-10 P04.40 is a billable code used to indicate a diagnosis of newborn affected by maternal use of unspecified drugs of addiction.

Key Diagnostic Point:

P04.40 refers to newborns who are affected by maternal use of unspecified drugs of addiction, which can include a range of substances such as opioids, stimulants, and other narcotics. These substances can cross the placenta during pregnancy or be transmitted through breast milk, leading to various neonatal complications. Newborns may present with withdrawal symptoms, growth restrictions, and other health issues that require careful monitoring and management. The clinical implications of this condition are significant, as affected infants may require specialized care in a Neonatal Intensive Care Unit (NICU) to address withdrawal symptoms, nutritional needs, and developmental support. The identification of maternal substance use is crucial for appropriate intervention and long-term follow-up, as these infants are at increased risk for developmental delays and behavioral issues later in life. Accurate coding is essential for ensuring that these newborns receive the necessary care and resources.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of substances that can affect coding specificity.
  • Need for detailed maternal history to determine substance use.
  • Potential overlap with other neonatal withdrawal syndromes.
  • Documentation requirements for maternal drug use and its effects.

Audit Risk Factors

  • Inadequate documentation of maternal substance use.
  • Failure to capture withdrawal symptoms in the newborn.
  • Misclassification of the type of substance used.
  • Inconsistent coding practices among healthcare providers.

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, feeding difficulties, or growth restrictions in the NICU.

Billing Considerations

Consideration of the timing of maternal substance use and its potential impact on neonatal outcomes.

Pediatrics

Documentation Requirements

Comprehensive developmental assessments and follow-up care plans for affected infants.

Common Clinical Scenarios

Pediatric evaluations of infants with a history of maternal substance use, focusing on developmental milestones.

Billing Considerations

Monitoring for long-term effects of in utero exposure to substances.

Coding Guidelines

Inclusion Criteria

Use P04.40 When
  • Coders should refer to the official ICD
  • CM guidelines for coding and reporting, ensuring that maternal substance use is documented clearly
  • Specific criteria for neonatal withdrawal and the impact of maternal drug use should be included in the medical record

Exclusion Criteria

Do NOT use P04.40 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

Used when a newborn affected by maternal drug use is admitted for monitoring.

Documentation Requirements

Documentation of maternal history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure comprehensive evaluations are documented.

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 newborns affected by maternal substance use. This specificity aids in resource allocation and care planning.

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 newborns affected by maternal substance use. This specificity aids in resource allocation and care planning.

Reimbursement & Billing Impact

reimbursement and care continuity.

Resources

Clinical References

  • •
    CDC Guidelines on Maternal Substance Use

Coding & Billing References

  • •
    CDC Guidelines on Maternal Substance Use

Frequently Asked Questions

What should be documented to support the use of code P04.40?

Documentation should include a detailed maternal history of substance use, any withdrawal symptoms observed in the newborn, and the clinical management provided. This ensures accurate coding and appropriate care planning.