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ICD-10 Guide
ICD-10 CodesP04.41

P04.41

Billable

Newborn affected by maternal use of cocaine

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

Code Description

ICD-10 P04.41 is a billable code used to indicate a diagnosis of newborn affected by maternal use of cocaine.

Key Diagnostic Point:

P04.41 refers to newborns who are affected by maternal cocaine use during pregnancy. Cocaine is a powerful stimulant that can cross the placenta and affect fetal development. Infants exposed to cocaine in utero may present with a range of symptoms, including low birth weight, irritability, feeding difficulties, and potential withdrawal symptoms. These infants are at risk for neurodevelopmental issues and may require specialized care in a neonatal intensive care unit (NICU). The effects of cocaine can also be compounded by the use of other substances, such as alcohol and tobacco, which can further impact the newborn's health. It is crucial for healthcare providers to conduct thorough assessments and provide appropriate interventions to support the infant's growth and development. Documentation should include maternal history, substance use patterns, and any observed neonatal symptoms to ensure accurate coding and care planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal substance use patterns
  • Potential co-occurring substance exposures
  • Need for comprehensive neonatal assessments
  • Documentation of withdrawal symptoms and treatment

Audit Risk Factors

  • Inadequate documentation of maternal substance use
  • Failure to document withdrawal symptoms
  • Misclassification of substance exposure
  • Lack of follow-up care documentation

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Neonatal documentation must include maternal history, substance use details, and any observed withdrawal symptoms in the newborn.

Common Clinical Scenarios

Common scenarios include infants presenting with irritability, feeding difficulties, or low birth weight due to maternal cocaine use.

Billing Considerations

Consideration must be given to the potential for co-occurring substance use and the need for multidisciplinary care.

Pediatrics

Documentation Requirements

Pediatric documentation should include developmental assessments and follow-up care plans for infants affected by maternal substance use.

Common Clinical Scenarios

Pediatric scenarios may involve ongoing monitoring for developmental delays or behavioral issues stemming from in utero exposure.

Billing Considerations

Pediatricians should be aware of the long-term implications of maternal substance use on child development.

Coding Guidelines

Inclusion Criteria

Use P04.41 When
  • Follow official ICD
  • 10 coding guidelines for perinatal conditions, ensuring accurate documentation of maternal substance use and its effects on the newborn
  • Specific criteria for coding should be adhered to, including the need for detailed maternal history

Exclusion Criteria

Do NOT use P04.41 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99291CPT Code

Critical care, evaluation and management of the newborn

Clinical Scenario

Used when a newborn requires intensive monitoring and management due to maternal substance exposure.

Documentation Requirements

Documentation must include the severity of the newborn's condition and the interventions provided.

Specialty Considerations

Neonatologists should ensure that all critical care services are well-documented to support billing.

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, including maternal substance use, which enhances the ability to track and manage these complex cases effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including maternal substance use, which enhances the ability to track and manage these complex cases effectively.

Reimbursement & Billing Impact

reimbursement and quality care.

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 are the long-term effects of cocaine exposure on newborns?

Long-term effects can include developmental delays, behavioral issues, and increased risk for learning disabilities. Continuous monitoring and early intervention are crucial for affected infants.