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ICD-10 Guide
ICD-10 CodesP04.16

P04.16

Billable

Newborn affected by maternal use of amphetamines

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

Code Description

ICD-10 P04.16 is a billable code used to indicate a diagnosis of newborn affected by maternal use of amphetamines.

Key Diagnostic Point:

Newborns affected by maternal use of amphetamines may present with a range of symptoms due to the exposure to these noxious substances during pregnancy. Amphetamines can cross the placenta and affect fetal development, leading to potential complications such as low birth weight, preterm birth, and withdrawal symptoms post-delivery. Clinical manifestations in the newborn may include irritability, feeding difficulties, tremors, and increased muscle tone. These infants may also exhibit signs of neonatal abstinence syndrome (NAS), which can complicate their care in the neonatal intensive care unit (NICU). The management of these newborns often requires a multidisciplinary approach, including pediatricians, neonatologists, and social services, to address both the medical and psychosocial needs of the infant and family. Accurate coding is essential for appropriate treatment planning and resource allocation, as well as for tracking outcomes related to maternal substance use during pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of affected newborns
  • Need for comprehensive maternal history documentation
  • Potential for co-occurring substance use disorders
  • Differentiation from other neonatal withdrawal syndromes

Audit Risk Factors

  • Inadequate documentation of maternal substance use history
  • Failure to document specific symptoms in the newborn
  • Misclassification of withdrawal symptoms
  • Lack of follow-up care documentation

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Detailed maternal history, including substance use patterns, and newborn assessment findings.

Common Clinical Scenarios

Infants presenting with irritability, feeding intolerance, and tremors in the NICU.

Billing Considerations

Consideration of potential long-term developmental assessments and follow-up care.

Pediatrics

Documentation Requirements

Documentation of developmental milestones and any ongoing treatment for withdrawal symptoms.

Common Clinical Scenarios

Pediatric follow-up visits for infants with a history of maternal amphetamine use.

Billing Considerations

Monitoring for behavioral and developmental issues as the child grows.

Coding Guidelines

Inclusion Criteria

Use P04.16 When
  • Follow the ICD
  • CM guidelines for coding perinatal conditions, ensuring accurate documentation of maternal substance use and the newborn's clinical presentation
  • Use additional codes for any associated conditions such as withdrawal symptoms

Exclusion Criteria

Do NOT use P04.16 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 amphetamine use requiring initial assessment.

Documentation Requirements

Document maternal history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure comprehensive 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 perinatal conditions, improving the ability to track outcomes related to maternal substance use and enhancing care planning for affected newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track outcomes related to maternal substance use and enhancing care planning for affected newborns.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, improving the ability to track outcomes related to maternal substance use and enhancing care planning for affected newborns.

Resources

Clinical References

  • •
    Substance Use in Pregnancy: A Guide for Healthcare Providers

Coding & Billing References

  • •
    Substance Use in Pregnancy: A Guide for Healthcare Providers

Frequently Asked Questions

What are the common symptoms of newborns affected by maternal amphetamine use?

Common symptoms include irritability, feeding difficulties, tremors, and signs of withdrawal. These infants may require specialized care in the NICU.