P04 vs Q86
P04 (Newborn affected by noxious substances transmitted via placenta or breast milk) compared with Q86 (Congenital malformation syndromes due to known exogenous causes, not elsewhere classified), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. Q86 carries an Excludes2 note covering P04: “nonteratogenic effects of substances transmitted via placenta or breast milk (P04.-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| P04Newborn affected by noxious substances transmitted via placenta or breast milk | Q86Congenital malformation syndromes due to known exogenous causes, not elsewhere classified | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header |
| Classification | P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96) | Q00-Q99 — Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-Q99) |
| Definition | Newborn affected by noxious substances transmitted via placenta or breast milk is a non-billable ICD-10-CM category code (P04). | Congenital malformation syndromes due to known exogenous causes, not elsewhere classified is a non-billable ICD-10-CM category code (Q86). |
| Includes | nonteratogenic effects of substances transmitted via placenta | — |
| Code first | any current condition in newborn, if applicable | — |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources