P04 — Newborn affected by noxious substances transmitted via placenta or breast milk
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
These codes carry an Excludes1 note pointing at P04. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P04 alone.
Risk adjustment
P04 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
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
Questions about P04
- Is P04 a billable ICD-10-CM code?
- No. P04 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does P04 sit in the tabular list?
- Certain conditions originating in the perinatal period (P00-P96), in the block Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04).