P00-P04 — Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery
ICD-10-CM codes P00-P04 cover newborn affected by maternal factors and by complications of pregnancy, labor, and delivery, within certain conditions originating in the perinatal period. The block holds 84 codes across 5 categories, of which 70 are billable and 14 are header codes that cannot be submitted on a claim.
Notes
Additional guidance from the ICD-10-CM tabular list.
- These codes are for use when the listed maternal conditions are specified as the cause of confirmed morbidity or potential morbidity which have their origin in the perinatal period (before birth through the first 28 days after birth).
Risk adjustment in P00-P04
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
- HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock
What else to watch in P00-P04
- 13 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in P00-P04
- P00Newborn affected by maternal conditions that may be unrelated to present pregnancy
- P01Newborn affected by maternal complications of pregnancy
- P02Newborn affected by complications of placenta, cord and membranes
- P03Newborn affected by other complications of labor and delivery
- P04Newborn affected by noxious substances transmitted via placenta or breast milk