Newborn affected by noxious substances transmitted via placenta or breast milk
In Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04), chapter 16: Certain Conditions Originating in the Perinatal Period
22 billable codes under P04: none are a CC or MCC; all map to HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications).An HCC counts toward a Medicare Advantage patient's risk score.
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Instructional notes
Includes: conditions that are coded here
- nonteratogenic effects of substances transmitted via placenta
Excludes2: not included here, code separately if applicable
- congenital malformations (Q00-Q99)
- encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)
- neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)
- newborn in contact with and (suspected) exposures hazardous to health not transmitted via placenta or breast milk (Z77.-)
Code first: code the underlying condition first, then this code
- any current condition in newborn, if applicable
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
Coding of conditions that originate from before birth through the 28th day after birth, including newborn record rules, prematurity, low birth weight, sepsis, and stillbirth.
- General Perinatal Rules (page 71)
- Observation and Evaluation of Newborns for Suspected Conditions not Found (page 73)
- Coding Additional Perinatal Diagnoses (page 73)
- Prematurity and Fetal Growth Retardation (page 73)
- Low birth weight and immaturity status (page 74)
- Bacterial Sepsis of Newborn (page 74)
- Stillbirth (page 74)
- COVID-19 Infection in Newborn (page 74)
All codes under P04
P04 can't be used on a claim. Pick a billable code below; grey headings group them.
- P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
- P04.1Newborn affected by other maternal medication
- P04.11Newborn affected by maternal antineoplastic chemotherapy
- P04.12Newborn affected by maternal cytotoxic drugs
- P04.13Newborn affected by maternal use of anticonvulsants
- P04.14Newborn affected by maternal use of opiates
- P04.15Newborn affected by maternal use of antidepressants
- P04.16Newborn affected by maternal use of amphetamines
- P04.17Newborn affected by maternal use of sedative-hypnotics
- P04.18Newborn affected by other maternal medication
- P04.19Newborn affected by maternal use of unspecified medication
- P04.1ANewborn affected by maternal use of anxiolytics
- P04.2Newborn affected by maternal use of tobacco
- P04.3Newborn affected by maternal use of alcohol
- P04.4Newborn affected by maternal use of drugs of addiction
- P04.40Newborn affected by maternal use of unspecified drugs of addiction
- P04.41Newborn affected by maternal use of cocaine
- P04.42Newborn affected by maternal use of hallucinogens
- P04.49Newborn affected by maternal use of other drugs of addiction
- P04.5Newborn affected by maternal use of nutritional chemical substances
- P04.6Newborn affected by maternal exposure to environmental chemical substances
- P04.8Newborn affected by other maternal noxious substances
- P04.81Newborn affected by maternal use of cannabis
- P04.89Newborn affected by other maternal noxious substances
- P04.9Newborn affected by maternal noxious substance, unspecified
P04 MS-DRG
As the principal diagnosis, all 22 billable codes under P04 group to MS-DRG 794 (v44.0).
Other codes that refer to P04
Notes on these codes point to P04.
- CH10 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH11 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH12 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH13 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH14 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH18 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH6 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH7 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH8 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- CH9 Excludes2: certain conditions originating in the perinatal period (P04-P96)
- P00 Excludes2: newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)
- Q86 Excludes2: nonteratogenic effects of substances transmitted via placenta or breast milk (P04.-)
- Z77 Excludes2: newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)
Code history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015.
- FY2017: Title changed. It was: Newborn (suspected to be) affected by noxious substances transmitted via placenta or breast milk.