P96.1

P96.1: Neonatal withdrawal symptoms from maternal use of drugs of addiction

Billable / specific codeICD-10-CM

P96.1 is a billable, specific ICD-10-CM code for neonatal withdrawal symptoms from maternal use of drugs of addiction. It is valid for submission on a claim.

Check P96.1 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)

Inclusion terms

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

Drug withdrawal syndrome in infant of dependent mother
Neonatal abstinence syndrome

Other codes that can never be billed with P96.1

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

P96.1 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

Abstinence symptoms, syndrome›neonatal
Newborn›abstinence syndrome
Syndrome›abstinence, neonatal
Syndrome›drug withdrawal, infant of dependent mother
Syndrome›neonatal abstinence
Newborn›affected by›neonatal abstinence syndrome
Withdrawal state›newborn›infant of dependent mother
Dependence›drug NEC›cocaine›withdrawal symptoms in newborn
Reaction›drug NEC›withdrawal›infant of dependent mother
Reaction›drug NEC›withdrawal›newborn
Syndrome›withdrawal›drug›infant of dependent mother

Code history

Unchanged in every release from FY2024 to FY2027.