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P04 ICD-10-CM Code: Newborn affected by noxious substances transmitted via placenta or breast milk

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

Tabular directives
1 inclusion term · 4 Excludes2 · 1 code-first instruction

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P04 in the official ICD-10-CM tabular list, quoted as published.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • nonteratogenic effects of substances transmitted via placenta

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code First

Underlying conditions that must be sequenced before this code.

  • any current condition in newborn, if applicable

Coder workflow for P04

MedCoder structured workflow — derived from this code’s own official record

Before you code P04

  1. P04 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewP04.0, P04.1, P04.2, P04.3, P04.4, P04.5, P04.6, P04.8, P04.9

    See the relationships section · Guide: How to choose an ICD-10-CM code →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath P04?
    Yes → Select that code and continue the checks below on its own page.
    No → P04 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewP04.0, P04.1, P04.2, P04.3, P04.4, P04.5, P04.6, P04.8, P04.9

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then P04.
    No → Continue; do not add an underlying condition the record does not document.

Consider P04. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The underlying (etiologic) condition
Named in the Code First note; sequenced before this code when documented (Guidelines I.A.13).

Official instructions as workflow

  • Excludes2 — not part of P04(4 notes)

    Coding workflow: The conditions named in this note are not included in P04. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareZ05, P58.4, Z77

    See the official tabular notes · Guidelines I.A.12.b

  • Code First — sequencing check(1 note)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before P04. Do not add an underlying condition the record does not document.

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The underlying condition the Code First note names is documented alongside this condition.

Coding question: How are the two sequenced?

Path: Review the Code First note.

Reason: The underlying condition is sequenced first and the manifestation follows (Guidelines I.A.13).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Newborn affected by noxious substances transmitted via placenta or breast milk is a non-billable ICD-10-CM category code (P04). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name P04 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes2 notes across 3 chapters: P00 — Newborn affected by maternal conditions that may be unrelated to present pregnancy, Q86 — Congenital malformation syndromes due to known exogenous causes, not elsewhere classified, Z77 — Other contact with and (suspected) exposures hazardous to health.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Contextual Map

Every relationship of P04 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run P04 with these 5 related codes in Claim Check

Hierarchy

Excludes2

Referenced by Excludes2 notes

Nearest codes (25)

Change history (2)

Common coding questions

Can P04 be billed directly?

No. P04 (Newborn affected by noxious substances transmitted via placenta or breast milk) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2017 — October 1, 2016
    Description revised
    Newborn (suspected to be) affected by noxious substances transmitted via placenta or breast milk → Newborn affected by noxious substances transmitted via placenta or breast milk
    FY2017 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Newborn (suspected to be) affected by noxious substances transmitted via placenta or breast milk

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P04 in its code family, with their registry titles.