P04
P04: Newborn affected by noxious substances transmitted via placenta or breast milk
Non-billable headerICD-10-CM
P04 is a non-billable header ICD-10-CM code for newborn affected by noxious substances transmitted via placenta or breast milk. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- 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
The underlying condition must be sequenced before this code.
- any current condition in newborn, if applicable
Includes
Conditions this code covers.
- nonteratogenic effects of substances transmitted via placenta
Other codes that can never be billed with P04
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Code history
Unchanged in every release from FY2024 to FY2027.
Code to one of these instead P04
9 child codes. Green means billable.
- P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
- P04.1Newborn affected by other maternal medication
- 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
- P04.5Newborn 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
- P04.9Newborn affected by maternal noxious substance, unspecified