Neonatal Abstinence Syndrome and Maternal Opioid-Related Diagnoses: Analysis of ICD-10-CM Transition, 2013-2017

Hosp Pediatr. 2021 Aug;11(8):902-908. doi: 10.1542/hpeds.2021-005845.


Background and objectives: Hospital discharge records remain a common data source for tracking the opioid crisis among pregnant women and infants. The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) transition from the International Classification of Diseases, Ninth Revision, Clinical Modification may have affected surveillance. Our aim was to evaluate this transition on rates of neonatal abstinence syndrome (NAS), maternal opioid use disorder (OUD), and opioid-related diagnoses (OUD with ICD-10-CM codes for long-term use of opioid analgesics and unspecified opioid use).

Methods: Data from the 2013-2017 Healthcare Cost and Utilization Project's National Inpatient Sample were used to conduct, interrupted time series analysis and log-binomial segmented regression to assess whether quarterly rates differed across the transition.

Results: From 2013 to 2017, an estimated 18.8 million birth and delivery hospitalizations were represented. The ICD-10-CM transition was not associated with NAS rates (rate ratio [RR]: 0.99; 95% confidence interval [CI]: 0.90-1.08; P = .79) but was associated with 11% lower OUD rates (RR: 0.89; 95% CI: 0.80-0.98; P = .02) and a decrease in the quarterly trend (RR: 0.98; 95% CI: 0.96-1.00; P = .04). The transition was not associated with maternal OUD plus long-term use rates (RR: 0.98; 95% CI: 0.89-1.09; P = .76) but was associated with a 20% overall increase in opioid-related diagnosis rates including long-term and unspecified use (RR: 1.20; 95% CI: 1.09-1.32; P < .001).

Conclusions: The ICD-10-CM transition did not appear to affect NAS. However, coding of maternal OUD alone may not capture the same population across the transition, which confounds the interpretation of trend data spanning this time period.

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Female
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • International Classification of Diseases
  • Neonatal Abstinence Syndrome* / diagnosis
  • Neonatal Abstinence Syndrome* / epidemiology
  • Opioid-Related Disorders* / diagnosis
  • Opioid-Related Disorders* / epidemiology
  • Pregnancy


  • Analgesics, Opioid