ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesP04.11

P04.11

Billable

Newborn affected by maternal antineoplastic chemotherapy

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

Code Description

ICD-10 P04.11 is a billable code used to indicate a diagnosis of newborn affected by maternal antineoplastic chemotherapy.

Key Diagnostic Point:

Newborns affected by maternal antineoplastic chemotherapy may present with a range of complications due to the exposure to cytotoxic agents during gestation. These agents can cross the placenta and affect fetal development, leading to potential neonatal issues such as low birth weight, growth retardation, and hematological abnormalities. The impact of chemotherapy on the newborn can vary based on the timing of exposure, the specific drugs used, and the duration of treatment. Common clinical manifestations include immunosuppression, increased risk of infections, and potential organ dysfunction. Neonates may also exhibit withdrawal symptoms if the mother was on certain medications. It is crucial for healthcare providers to monitor these infants closely for any signs of complications and to provide appropriate supportive care. Documentation should include maternal history of chemotherapy, specific drugs administered, and any observed neonatal complications to ensure accurate coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal chemotherapy regimens
  • Potential for multiple neonatal complications
  • Need for detailed maternal history
  • Differentiation from other perinatal substance exposures

Audit Risk Factors

  • Inadequate documentation of maternal chemotherapy
  • Failure to capture all neonatal complications
  • Misclassification of drug exposure
  • Lack of follow-up documentation on neonatal outcomes

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed records of maternal chemotherapy, neonatal assessments, and any interventions performed.

Common Clinical Scenarios

Neonates presenting with low birth weight, signs of infection, or hematological issues in the NICU.

Billing Considerations

Close monitoring for withdrawal symptoms and complications related to immunosuppression.

Pediatrics

Documentation Requirements

Comprehensive history of maternal drug use and any ongoing pediatric assessments.

Common Clinical Scenarios

Pediatric follow-up for developmental delays or health issues stemming from in utero exposure.

Billing Considerations

Consideration of long-term effects of maternal chemotherapy on child development.

Coding Guidelines

Inclusion Criteria

Use P04.11 When
  • Follow the official ICD
  • CM coding guidelines for perinatal conditions, ensuring that maternal history is well
  • documented and that all neonatal complications are captured accurately

Exclusion Criteria

Do NOT use P04.11 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 assessments of newborns affected by maternal chemotherapy.

Documentation Requirements

Document maternal history and any immediate neonatal complications.

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, improving the ability to capture the nuances of maternal drug exposure 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 nuances of maternal drug exposure 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 nuances of maternal drug exposure and its effects on newborns.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Coding & Billing References

  • •
    American Academy of Pediatrics - Neonatal Coding Guidelines

Frequently Asked Questions

What should be documented to support the use of code P04.11?

Documentation should include a detailed maternal history of chemotherapy, specific drugs used, timing of exposure, and any observed neonatal complications. Additionally, ongoing assessments and interventions for the newborn should be recorded to ensure accurate coding.