Coding and coverage · ICD-10-CM

P04

P04.4 Newborn affected by maternal use of drugs of addiction

Not billable (header)Chapter 16

Report one of the more specific codes below.

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Codes under this one

  • P04.40 Newborn affected by maternal use of unspecified drugs of addiction
  • P04.41 Newborn affected by maternal use of cocaine
  • P04.42 Newborn affected by maternal use of hallucinogens
  • P04.49 Newborn affected by maternal use of other drugs of addiction

Instructional notes

Chapter 16

Excludes2Not included here: the patient may have both; report both when both are present.
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • tetanus neonatorum (A33)
Includes
  • conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs later
Notes
  • Codes from this chapter are for use on newborn records only, never on maternal records

Section P00-P04

Notes
  • These codes are for use when the listed maternal conditions are specified as the cause of confirmed morbidity or potential morbidity which have their origin in the perinatal period (before birth through the first 28 days after birth).

P04

Excludes2Not included here: the patient may have both; report both when both are present.
  • 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.-)
Code firstSequence the underlying condition first.
  • any current condition in newborn, if applicable
Includes
  • nonteratogenic effects of substances transmitted via placenta

Chapter 16: Certain conditions originating in the perinatal period · P00-P04 Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04)

Source: ICD-10-CM FY 2027 code descriptions and tabular list (CMS and CDC National Center for Health Statistics), effective 2026-10-01 through 2027-09-30 · CMS ICD-10 files. HCC mapping: CMS-HCC V28, payment year 2027. As of 2026-11-04.

Coverage and payment depend on the claim details; confirm with the Medicare Administrative Contractor.