TEIS Updates Eligibility Diagnosis List to Address Impact of Prenatal Substance Exposure

In December 2019, TEIS, in collaboration with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP), met with a group of neonatologists, pediatricians  and other stakeholders to develop recommendations to ensure TEIS's eligibility guidelines are reflective of current clinical practices in regard to diagnosis and coding of neonatal abstinence syndrome (NAS). 

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In recent years, TEIS's eligibility specialists had noted changes and regional differences in the application of the NAS diagnosis and had expressed concern that this could lead TEIS to miss children with opioid and other substance exposure that could impact the child's future development. This is of particular concern, as children with opioid or other substance exposure do not always exhibit developmental delays that would qualify them for TEIS services.

TEIS brought this concern to the attention of TNAAP who began following-up on this concern. TNAAP was able to verify that the clinical application of the diagnosis had been updated, which could potentially be resulting in children not being eligible for TEIS services. This concern led to the convening of the December 2019 meeting, which was attended by the following individuals:

  • Amy Coble, Chief of Staff for Tennessee Department of Children's Services
  • Brenda Barker, Tennessee Initiative for Perinatal Quality Care (TIPQC)
  • Davida Singleton, Early Childhood Epidemiologist, Tennessee Department of Health
  • Dr. Anna Morad, Vanderbilt Newborn Nursery Director and TIPQC Medical Director
  • Dr. Bruce Davis, Clinical Director for Tennessee Department of Developmental and Intellectual Disabilities
  • Dr. Larry Faust, Developmental Pediatrician and Coding Consultant for TNAAP
  • Dr. Stacy Slagle, Neonatologist for Jackson-Madison County General Hospital and Vanderbilt
  • Dr. Stephen Patrick, Vanderbilt Pediatric Neonatologist
  • Jennifer Rose, Eligibility Specialist for TEIS
  • Ruth Allen, Executive Director of TNAAP
  • Shannon Pargin, Strategic Planning Coordinator for TEIS
  • Susan Rollyson, Program Manager of TNAAP

As a result of this meeting and after follow-up with TEIS leadership and TEIS's State Interagency Coordinating Council, the following diagnosis codes have been added to the TEIS diagnosis list:

  • P04.14 Newborn affected by maternal use of opiates
  • P04.16 Newborn affected by maternal use of amphetamines
  • P04.3 Newborn affected by maternal use of alcohol
  • P04.4- Newborn affected by maternal use of drugs of addiction
  • P04.8- Newborn affected by other maternal noxious substances

These codes have been added with a notation that they require secondary medical review for eligibility. This notation does not require providers or families to obtain a second opinion; it refers to an internal TEIS process where district eligibility specialists send records for children who would only be eligible by one of these codes (not by delay) to the TEIS central office for additional review. This allows the central office to gather additional data in order to better inform the eligibility diagnosis list. When needed, a developmental pediatrician on contract with TEIS from TNAAP reviews the records and makes recommendations about eligibility. 

With the addition of these diagnosis codes in particular, TEIS is concerned about the impact of the prenatal drug exposure on the newborn. It would be helpful if the provider addresses the specifics of the drug exposure (types of substances, duration, quantity, clinical symptoms, etc.) and how they affected the infant in a discharge summary or discharge note that is provided to TEIS. 

In addition to these codes, TEIS add code P77-, necrotizing enterocolitis, to the diagnosis list. The changes to the diagnosis list went into effect Feb. 1. The complete diagnosis list can be found in the 
TEIS Eligibility section of the TEIS website. Questions may be directed to Shannon.Pargin@tn.gov.

Tennessee Chapter American Academy of Pediatrics