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Trends in Neonatal Opioid Withdrawal Syndrome and Opioid Exposure Diagnoses Among Infants With Private Health

Angela G Campbell1, Pengyue Zhang2, Marc B Rosenman3,4,5

  • 1Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA.

Public Health Reports (Washington, D.C. : 1974)
|April 29, 2023
PubMed

Insights

A new ICD-10-CM code for neonatal opioid exposure (P04.14) altered diagnosis coding. While use of specific withdrawal codes decreased, the use of multiple codes for neonatal opioid cases increased, suggesting diagnostic ambiguity.

Area of Science:

  • Neonatal Health
  • Public Health Surveillance
  • Medical Coding

Background:

  • The opioid epidemic has increased neonatal opioid withdrawal syndrome (NOWS) diagnoses.
  • States use ICD-10-CM code P96.1 for NOWS, but a new code (P04.14) for neonatal opioid exposure without significant withdrawal symptoms was introduced in October 2018.

Purpose of the Study:

  • To analyze the impact of the P04.14 code on the incidence rates of NOWS (P96.1) and other neonatal drug exposure diagnoses (P04.49).
  • To examine changes in diagnostic coding practices following the introduction of the P04.14 code.

Main Methods:

  • Utilized private health insurance data for US infants from Q1 2016 to Q3 2021.
  • Described incidence rates for P96.1, P04.14, and P04.49 codes over time.
  • Examined changes in code usage before and after October 2018.

Main Results:

  • Exclusive use of P96.1 (NOWS) declined by 35.7% (1.08 to 0.70 per 1000 births) between 2016-2018 and 2019-2021.
  • Use of P04.49 (other neonatal drug exposure) declined by 30.0% (2.34 to 1.64 per 1000 births).
  • Use of multiple codes for neonatal opioid cases increased by 45.5% (0.56 to 0.79 per 1000 births).

Conclusions:

  • The introduction of ICD-10-CM code P04.14 influenced the utilization of other neonatal opioid-related diagnosis codes.
  • Increased use of multiple codes suggests potential ambiguity in selecting the most appropriate ICD-10-CM code for neonatal opioid exposure and withdrawal.
Abstract

Keywords:
consoleeatneonatal abstinence syndromeneonatal opioid withdrawal syndromeopioid epidemicsleep

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