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P04.1 vs P58.4

P04.1 (Newborn affected by other maternal medication) 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 P04.1 lists P58.4 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named.P04.1 is “Newborn affected by other maternal medication”; P58.4 is “Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn”.

Registry fact

Can these codes be reported together?

Yes, when both are documented.P04.1 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. P04.1 carries 2 Excludes1 notes and P58.4 carries 6 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.P04.1’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?

Both are headers.Both are non-billable headers, and neither contains the other.

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

P04.1
Newborn affected by other maternal medication
↔
P58.4
Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn

What we found

Yes, when both are documented.P04.1 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

P04.1Newborn affected by other maternal medicationP58.4Neonatal jaundice due to drugs or toxins transmitted from mother or given to newborn
Billing statusNon-billable header

Report instead: P04.11, P04.12, P04.13, P04.14, P04.15

Non-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 other maternal medication is a non-billable ICD-10-CM category code (P04.1).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
—
Excludes1
dysmorphism due to warfarin (Q86.2)
fetal hydantoin syndrome (Q86.1)
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
maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)
maternal use of drugs of addiction (P04.4-)
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
, if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)
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.

Edit this comparisonCheck a whole claim

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