E80.4 vs P58.4

E80.4 (Gilbert syndrome) compared with P58.4 (Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn), from the official CMS tabular data.

Summary

These codes should not be reported together because P58.4’s tabular entry lists E80.4 under Excludes1.

Official rule

What is different?

The conditions named, billing status and chapter.E80.4 is “Gilbert syndrome”; P58.4 is “Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn”. P58.4 is a non-billable header; E80.4 is billable. E80.4 sits in E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89); P58.4 in P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96).

Registry fact

Can these codes be reported together?

No.P58.4’s entry carries an Excludes1 note covering E80.4: “Gilbert syndrome (E80.4)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.P58.4’s tabular entry: “Gilbert syndrome (E80.4)”. The note covers E80.4.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. E80.4 carries 1 Excludes2 note covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.P58.4 is a non-billable header, but E80.4 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Conflict

Excludes1 conflict

P58.4

Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn

↔

E80.4

Gilbert syndrome

What we found

No — do not report together.P58.4 carries an Excludes1 note covering E80.4: “Gilbert syndrome (E80.4)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2 Check these on a claim

Why it matters

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

Section I.A.12.a — Excludes1 · applies to: Excludes1
A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.
ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

	E80.4Gilbert syndrome	P58.4Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn
Billing status	Billable	Non-billable header Report instead: P58.41, P58.42
Classification	E00-E89 — Endocrine, Nutritional and Metabolic Diseases (E00-E89)	P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96)
Definition	Gilbert syndrome is a billable ICD-10-CM diagnosis code (E80.4).	Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn is a non-billable ICD-10-CM category code (P58.4).
Includes	defects of catalase and peroxidase	—
Excludes1	androgen insensitivity syndrome (E34.5-) congenital adrenal hyperplasia (E25.0) hemolytic anemias attributable to enzyme disorders (D55.-) Marfan syndrome (Q87.4-) 5-alpha-reductase deficiency (E29.1)	jaundice due to isoimmunization (P55-P57) congenital stenosis and stricture of bile ducts (Q44.3) Crigler-Najjar syndrome (E80.5) Dubin-Johnson syndrome (E80.6) Gilbert syndrome (E80.4) hereditary hemolytic anemias (D55-D58)
Excludes2	Ehlers-Danlos syndromes (Q79.6-)	—
Code first	—	poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)
Use additional code	—	code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources