Pediatric Coding Alert

When a baby is (or might be) born affected by drugs or alcohol, the attending pediatrician can face difficulties coding the initial evaluation, and especially arriving at appropriate diagnoses. Sometimes symptoms are clear and can be easily listed, while at other times they are not readily apparent. Likewise, the pediatrician may not know if the mother has a history of alcohol or drug abuse. Older infants and children diagnosed for the first time with conditions caused by prenatal drug use can pose the same difficulties. To choose the most accurate diagnosis, pediatricians must consider the clinical information available and how that information fits existing ICD-9 codes.
 
Symptoms and Testing
According to Ira Chasnoff, MD, FAAP, president of Children's Research Triangle, a Chicago-based nonprofit organization that focuses on high-risk children, the best diagnosis code range for these cases is 760.7x (noxious influences affecting fetus via placenta or breast milk). The fifth digit of the ICD-9 code identifies the exact substance(s) the mother used, e.g., 760.72, ... narcotics.
 
Establishing a diagnosis is relatively simple when the symptoms are obvious, Chasnoff says, and is even simpler when the obstetric history shows maternal drug use. But do not code 760.7x based on maternal history alone. There must be documented symptomatology in the child as well.
 
Evidence of illegal substances in the mother's or newborn's urine is a clear although rare sign of drug exposure, Chasnoff says. You cannot, however, depend on drug tests to indicate prenatal drug exposure, which most likely occurred in the months before labor. Urine toxicology is usually negative because the metabolites are excreted within 48 hours of use. Furthermore, the presence of alcohol is not reflected in urine tests, only in blood tests (a moot point, as mothers don't drink in the hospital labor and delivery units).
 
Women often receive therapeutic medication during labor. Even though the effects of such medication notably, Demerol can confound simple urine toxicology results for narcotics, there are more specific tests to distinguish Demerol and other drugs, for instance, heroin. If the mother receives painkillers or other drugs during labor and/or delivery that harm the infant, report 763.5 (fetus or newborn affected by other complications of labor and delivery; maternal anesthesia and analgesia).

Maternal History
There is no code for a documented maternal history of drug or alcohol abuse, but because this clinical information affects the fetus, a 760.xx diagnosis is appropriate. You will need the maternal history to pinpoint the correct 760.xx code, however. There are no clear symptoms specific to each kind of drug" " Chasnoff says. Symptoms are general. Therefore you must rely on the maternal history to know if the drug used was cocaine heroin or something else.
 
For instance when Chasnoff's group [...]