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P04.18 vs P04.4

P04.18 (Newborn affected by other maternal medication) compared with P04.4 (Newborn affected by maternal use of drugs of addiction), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes can be reported together when both conditions are documented, because P04.18 lists P04.4 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

Title wording and billing status.The titles share “Newborn affected by”; P04.18 says “other maternal medication” where P04.4 says “maternal use of drugs of addiction”. P04.4 is a non-billable header; P04.18 is billable.

Registry fact

Can these codes be reported together?

Yes, when both are documented.P04.18 lists P04.4 under Excludes2: “maternal use of drugs of addiction (P04.4-)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

Yes.P04.18’s tabular entry: “maternal use of drugs of addiction (P04.4-)”. The note covers P04.4.

Official ruleGuide: Excludes1 vs Excludes2

Is one a parent or header code?

One is a header.P04.4 is a non-billable header, but P04.18 is not one of its subdivisions.

Registry fact

Nothing found in 4 other checks
Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. P04.18 carries 2 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

No.Neither is a subdivision of the other, and neither title is the unspecified form; they describe different conditions within category P04.

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

P04.18
Newborn affected by other maternal medication
↔
P04.4
Newborn affected by maternal use of drugs of addiction

What we found

Yes, when both are documented.P04.18 carries an Excludes2 note covering P04.4: “maternal use of drugs of addiction (P04.4-)”

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 FY2027

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

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
P04.18

Newborn affected by other maternal medication

P04.4

Newborn affected by maternal use of drugs of addiction

StatusDiffers
P04.18
Billable
P04.4
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: P04.40, P04.41, P04.42, P04.49

Excludes1Differs
P04.18
  • dysmorphism due to warfarin (Q86.2)
  • fetal hydantoin syndrome (Q86.1)
P04.4

None at this code

Excludes2Differs
Only at P04.18
  • maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)
  • maternal use of drugs of addiction (P04.4-)
Only at P04.4

No note of its own beyond the shared notes

Shared by both codes (4 notes)
  • 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 firstDiffers
Only at P04.18
  • , if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
  • withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)
Only at P04.4

No note of its own beyond the shared notes

Shared by both codes (1 note)
  • any current condition in newborn, if applicable
CategorySame for both

P04 Newborn affected by noxious substances transmitted via placenta or breast milk

ChapterSame for both

P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96)

IncludesSame for both
  • nonteratogenic effects of substances transmitted via placenta

No Use additional code, Code also and 7th character note at either code.

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. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.

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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