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v1.0.0
ICD-10 Guide
ICD-10 CodesP04.42

P04.42

Billable

Newborn affected by maternal use of hallucinogens

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

Code Description

ICD-10 P04.42 is a billable code used to indicate a diagnosis of newborn affected by maternal use of hallucinogens.

Key Diagnostic Point:

Newborns affected by maternal use of hallucinogens represent a significant concern in perinatal medicine. Hallucinogens, which include substances such as LSD, psilocybin mushrooms, and mescaline, can cross the placenta and affect fetal development. The impact on the newborn can vary widely, ranging from mild behavioral disturbances to severe neurodevelopmental issues. Clinical manifestations may include irritability, sleep disturbances, and potential withdrawal symptoms. The timing and quantity of maternal drug use, as well as the presence of other substances, can influence the severity of the newborn's condition. It is crucial for healthcare providers to conduct thorough assessments and monitor the newborn for any signs of complications. Documentation should include maternal history of substance use, any observed symptoms in the newborn, and the management strategies employed. This code is essential for capturing the complexities of care required for these infants, ensuring appropriate resources and interventions are allocated.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal substance use patterns
  • Potential co-occurring substance exposures
  • Diverse clinical presentations in affected newborns
  • Need for comprehensive maternal and neonatal documentation

Audit Risk Factors

  • Inadequate documentation of maternal substance use history
  • Failure to document clinical signs in the newborn
  • Misclassification of the type of substance used
  • Lack of interdisciplinary notes on management

Specialty Focus

Medical Specialties

Neonatology

Documentation Requirements

Neonatal documentation must include detailed maternal history, newborn assessment findings, and any interventions provided.

Common Clinical Scenarios

Common scenarios include newborns presenting with irritability, feeding difficulties, or abnormal neurological assessments in the NICU.

Billing Considerations

Accurate coding requires understanding the nuances of maternal drug use and its potential effects on the newborn.

Pediatrics

Documentation Requirements

Pediatric documentation should reflect ongoing assessments of developmental milestones and behavioral observations.

Common Clinical Scenarios

Pediatric scenarios may involve follow-up visits for developmental delays or behavioral issues stemming from prenatal exposure.

Billing Considerations

Pediatricians must be aware of the long-term implications of prenatal hallucinogen exposure on child development.

Coding Guidelines

Inclusion Criteria

Use P04.42 When
  • Perinatal coding guidelines emphasize the importance of capturing maternal substance use history and the clinical presentation of the newborn
  • Specific criteria include detailed documentation of symptoms, maternal drug use patterns, and any interventions provided

Exclusion Criteria

Do NOT use P04.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99460CPT Code

Initial hospital care, newborn

Clinical Scenario

Used for the initial assessment of a newborn affected by maternal hallucinogen use.

Documentation Requirements

Documentation must include maternal history and newborn assessment findings.

Specialty Considerations

Neonatologists should ensure thorough documentation of all assessments and interventions.

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 the effects of hallucinogens, which were less clearly defined in ICD-9. This specificity aids in better tracking and management of affected newborns.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of perinatal conditions, including the effects of hallucinogens, which were less clearly defined in ICD-9. This specificity aids in better tracking and management of affected newborns.

Reimbursement & Billing Impact

reimbursement and resource allocation.

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 long-term effects of hallucinogen exposure on newborns?

Long-term effects can vary widely, but may include developmental delays, behavioral issues, and potential neurodevelopmental disorders. Ongoing monitoring and support are crucial for affected children.