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ICD-10 Guide
ICD-10 CodesP04.81

P04.81

Billable

Newborn affected by maternal use of cannabis

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

Code Description

ICD-10 P04.81 is a billable code used to indicate a diagnosis of newborn affected by maternal use of cannabis.

Key Diagnostic Point:

Newborns affected by maternal cannabis use may present with a variety of symptoms and complications due to the exposure to tetrahydrocannabinol (THC) and other cannabinoids during gestation. Maternal cannabis use can lead to low birth weight, preterm birth, and potential neurodevelopmental issues. The effects of cannabis on the fetus are still being studied, but evidence suggests that it may impact the developing brain and lead to behavioral issues later in life. Newborns may exhibit withdrawal symptoms, such as irritability, tremors, and feeding difficulties. It is crucial for healthcare providers to assess the newborn's condition thoroughly and provide appropriate interventions. Documentation should include maternal history of substance use, any observed symptoms in the newborn, and the care provided in the neonatal intensive care unit (NICU) or nursery. Accurate coding is essential for proper treatment planning and follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal substance use patterns
  • Differential diagnosis with other perinatal conditions
  • Need for comprehensive maternal history documentation
  • Potential for co-occurring substance use disorders

Audit Risk Factors

  • Inadequate documentation of maternal substance use
  • Failure to document newborn symptoms accurately
  • Misclassification of the severity of the condition
  • Lack of follow-up documentation for affected newborns

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal history, newborn assessment notes, and any interventions provided.

Common Clinical Scenarios

Newborns presenting with irritability, feeding difficulties, or low birth weight in the NICU.

Billing Considerations

Consider the potential for withdrawal symptoms and the need for supportive care.

Pediatrics

Documentation Requirements

Comprehensive developmental assessments and follow-up care plans.

Common Clinical Scenarios

Pediatric visits for developmental delays or behavioral issues linked to prenatal cannabis exposure.

Billing Considerations

Monitor for long-term effects on behavior and cognitive development.

Coding Guidelines

Inclusion Criteria

Use P04.81 When
  • Follow the official ICD
  • CM coding guidelines for perinatal conditions, ensuring accurate documentation of maternal substance use and newborn symptoms
  • Use additional codes as necessary to capture any co
  • occurring conditions

Exclusion Criteria

Do NOT use P04.81 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 when assessing a newborn affected by maternal cannabis use.

Documentation Requirements

Document maternal history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure thorough evaluations are conducted.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like P04.81, improving the ability to track and manage the effects of maternal cannabis use on newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like P04.81, improving the ability to track and manage the effects of maternal cannabis use on newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like P04.81, improving the ability to track and manage the effects of maternal cannabis use on newborns.

Resources

Clinical References

  • •
    CDC Guidelines on Substance Use in Pregnancy

Coding & Billing References

  • •
    CDC Guidelines on Substance Use in Pregnancy

Frequently Asked Questions

What are the long-term effects of maternal cannabis use on newborns?

Research indicates potential long-term effects on cognitive development and behavior, necessitating ongoing monitoring and support for affected children.