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ICD-10 Guide
ICD-10 CodesP04.49

P04.49

Billable

Newborn affected by maternal use of other drugs of addiction

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

Code Description

ICD-10 P04.49 is a billable code used to indicate a diagnosis of newborn affected by maternal use of other drugs of addiction.

Key Diagnostic Point:

P04.49 refers to newborns who are affected by maternal use of drugs of addiction that are not classified under specific categories such as opioids or alcohol. This includes a range of substances that may be transmitted to the fetus through the placenta or to the infant through breast milk. The clinical implications can vary widely, including withdrawal symptoms, developmental delays, and other health complications. Newborns may present with irritability, feeding difficulties, and abnormal neurological signs. The management of these infants often requires a multidisciplinary approach, including neonatologists, pediatricians, and social services, to address both the medical and psychosocial needs of the family. Accurate coding is essential for appropriate treatment planning and resource allocation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of substances involved (e.g., prescription medications, illicit drugs)
  • Potential for overlapping symptoms with other conditions
  • Need for comprehensive maternal history and documentation
  • Variability in clinical presentation among affected newborns

Audit Risk Factors

  • Inadequate maternal history documentation
  • Failure to document specific substances used
  • Misclassification of withdrawal symptoms
  • Lack of follow-up care documentation

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal substance use history, newborn assessment findings, and treatment plans.

Common Clinical Scenarios

Newborns presenting with withdrawal symptoms in the NICU, requiring monitoring and supportive care.

Billing Considerations

Consideration of the timing of maternal drug use during pregnancy and its impact on neonatal outcomes.

Pediatrics

Documentation Requirements

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

Common Clinical Scenarios

Pediatric evaluations of infants with developmental delays linked to maternal substance use.

Billing Considerations

Long-term follow-up for developmental milestones and potential behavioral issues.

Coding Guidelines

Inclusion Criteria

Use P04.49 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of maternal substance use and its effects on the newborn
  • Specific criteria include the need for clinical evidence of the newborn's condition and the relationship to maternal drug use

Exclusion Criteria

Do NOT use P04.49 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care for newborns

Clinical Scenario

Used for newborns requiring evaluation and management due to maternal substance use.

Documentation Requirements

Detailed history and physical examination findings.

Specialty Considerations

Neonatologists should document specific assessments related to withdrawal symptoms.

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 capture the complexities of maternal substance use and its effects on newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the complexities of maternal substance use and its effects on newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to capture the complexities of maternal substance use and its effects on newborns.

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 documentation is required for coding P04.49?

Documentation must include a detailed maternal history of substance use, clinical assessments of the newborn, and any treatment provided. It is crucial to link the newborn's symptoms to maternal drug use.