Is P04.1 a billable ICD-10-CM code?

No. P04.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does P04.1 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).

What cannot be coded together with P04.1?

P04.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

P04.1

P04.1 — Newborn affected by other maternal medication

Non-billable headerICD-10-CM

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.

dysmorphism due to warfarin (Q86.2)
fetal hydantoin syndrome (Q86.1)

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.

maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)
maternal use of drugs of addiction (P04.4-)

Code first

The underlying condition must be sequenced before this code.

, if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)

Other codes that can never be billed with P04.1

These codes carry an Excludes1 note pointing at P04.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P04.1 alone.

P93Reactions and intoxications due to drugs administered to newborn

Risk adjustment

P04.1 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 P04.1

10 child codes. Green means billable.

Related codes at this level

Codes that share P04. If P04.1 is not quite right, the correct code is usually one of these.

Questions about P04.1

Is P04.1 a billable ICD-10-CM code?: No. P04.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does P04.1 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).
What cannot be coded together with P04.1?: P04.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.