P04.40
P04.40: Newborn affected by maternal use of unspecified drugs of addiction
Billable / specific codeICD-10-CM
P04.40 is a billable, specific ICD-10-CM code for newborn affected by maternal use of unspecified drugs of addiction. It is valid for submission on a claim.
Check P04.40 with the rest of the claim: free scrubberExcludes2 inherited from the categories above P04.40
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.-)
Risk adjustment
P04.40 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
- Newborn›affected by›drugs of addiction
- Absorption›drug NEC›addictive›through placenta(newborn)
Code history
Unchanged in every release from FY2024 to FY2027.