P04.0

P04.0: Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery

Billable / specific codeICD-10-CM

P04.0 is a billable, specific ICD-10-CM code for newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery. It is valid for submission on a claim.

Check P04.0 with the rest of the claim: free scrubber

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.

newborn affected by other maternal medication (P04.1-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery

Excludes2 inherited from the categories above P04.0

Not part of this code, but both may be coded when both are present.

Written on P04: Newborn affected by noxious substances transmitted via placenta or breast milk

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.-)

Other codes that can never be billed with P04.0

Their own Excludes1 notes name this code, so the conflict is not listed above.

P93Reactions and intoxications due to drugs administered to newborn
P96.1Neonatal withdrawal symptoms from maternal use of drugs of addiction

Risk adjustment

P04.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications0.424 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Alphabetic index entries that lead here

Absorption›chemical›through placenta›obstetric anesthetic or analgesic drug
Absorption›drug NEC›through placenta›obstetric anesthetic or analgesic drug
Newborn›affected by›maternal›analgesia(maternal)
Newborn›affected by›maternal›anesthesia(maternal)
Newborn›affected by›maternal›tranquilizers administered for procedures during pregnancy or labor and delivery
Newborn›affected by›maternal›opiates›administered for procedures during pregnancy or labor and delivery

Code history

Unchanged in every release from FY2024 to FY2027.