P04.1: Newborn affected by other maternal medication
P04.1 is a non-billable header ICD-10-CM code for newborn affected by other maternal medication. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
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.
Code first
The underlying condition must be sequenced before this code.
Excludes2 inherited from the categories above P04.1
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 P04.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- P93Reactions and intoxications due to drugs administered to newborn
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 P04.1
10 child codes. Green means billable.
- 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
- P04.1ANewborn affected by maternal use of anxiolytics
- P04.18Newborn affected by other maternal medication
- P04.19Newborn affected by maternal use of unspecified medication
Other codes under P04
- P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
- 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