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P04.0 vs P58.4

P04.0 (Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery) 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 can be reported together when both conditions are documented, because P04.0 lists P58.4 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and billing status.P04.0 is “Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery”; P58.4 is “Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn”. P58.4 is a non-billable header; P04.0 is billable.

Registry fact

Can these codes be reported together?

Yes, when both are documented.P04.0 lists P58.4 under Excludes2: “neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. P58.4 carries 6 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.P04.0’s tabular entry: “neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)”. The note covers P58.4.

Official ruleGuide: Excludes1 vs Excludes2

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 P04.0 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?

Informational

Excludes2 relationship

P04.0
Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
↔
P58.4
Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn

What we found

Yes, when both are documented.P04.0 carries an Excludes2 note covering P58.4: “neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    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

P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and deliveryP58.4Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn
Billing statusBillableNon-billable header

Report instead: P58.41, P58.42

ClassificationP00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96)P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96)
DefinitionNewborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery is a billable ICD-10-CM diagnosis code (P04.0).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
nonteratogenic effects of substances transmitted via placenta
Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery
—
Excludes1—
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
newborn affected by other maternal medication (P04.1-)
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 first
any current condition in newborn, if applicable
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