P04.0 ICD-10-CM Code: Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P04.0 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on P04.0 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for P04.0

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

Choose the right path

1. Is the underlying (etiologic) condition the Code First note names documented?
   Yes → Sequence the underlying condition first, then P04.0.
   No → Continue; do not add an underlying condition the record does not document.

Consider P04.0. 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 P04.0(5 notes)

  Coding workflow: The conditions named in this note are not included in P04.0. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareP04.1, Z05, 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 P04.0. 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

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.

Indexed Clinical Terms (6)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Absorption, chemical, through placenta (newborn), obstetric anesthetic or analgesic drug
• Absorption, drug NEC, through placenta (newborn), obstetric anesthetic or analgesic drug
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), analgesia (maternal)
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), anesthesia (maternal)
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), opiates, administered for procedures during pregnancy or labor and delivery
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), tranquilizers administered for procedures during pregnancy or labor and delivery

Don’t confuse P04.0 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of P04.0 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• P04.9— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Newborn affected by maternal noxious substance, unspecified” takes P04.9; specificity in the record moves it back here.

  Full comparison: P04.0 vs P04.9 →

• P04.1— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of newborn affected by other maternal medication adds P04.1; it is not part of this code and both may be reported when both are documented.

  Full comparison: P04.0 vs P04.1 →

• Q00— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital malformations adds Q00; it is not part of this code and both may be reported when both are documented.

  Full comparison: P04.0 vs Q00 →

• Q99— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of congenital malformations adds Q99; it is not part of this code and both may be reported when both are documented.

  Full comparison: P04.0 vs Q99 →

• Z05— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of encounter for observation of newborn for suspected diseases and conditions ruled out adds Z05; it is not part of this code and both may be reported when both are documented.

  Full comparison: P04.0 vs Z05 →

• P58.4— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother adds P58.4; it is not part of this code and both may be reported when both are documented.

  Full comparison: P04.0 vs P58.4 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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 P04.0 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 2 Excludes1 notes: P93 — Reactions and intoxications due to drugs administered to newborn, P96.1 — Neonatal withdrawal symptoms from maternal use of drugs of addiction.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 5 Excludes2 notes across 3 chapters: P00 — Newborn affected by maternal conditions that may be unrelated to present pregnancy (via P04.-), P04.1 — Newborn affected by other maternal medication, P04.49 — Newborn affected by maternal use of other drugs of addiction, Q86 — Congenital malformation syndromes due to known exogenous causes, not elsewhere classified (via P04.-), Z77 — Other contact with and (suspected) exposures hazardous to health (via P04.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 1 MS-DRG: DRG 794 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PNL010 — Newborn affected by maternal conditions or complications of labor/delivery (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) for risk-adjusted payment.

F19.922 — Other psychoactive substance use, unspecified with intoxication with perceptual disturbance, F19.929 — Other psychoactive substance use, unspecified with intoxication, unspecified, F19.930 — Other psychoactive substance use, unspecified with withdrawal, uncomplicated, F19.939 — Other psychoactive substance use, unspecified with withdrawal, unspecified, F19.94 — Other psychoactive substance use, unspecified with psychoactive substance-induced mood disorder, F19.980 — Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder, F19.981 — Other psychoactive substance use, unspecified with psychoactive substance-induced sexual dysfunction, F19.982 — Other psychoactive substance use, unspecified with psychoactive substance-induced sleep disorder, F19.988 — Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder, F19.99 — Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder, P04.11 — Newborn affected by maternal antineoplastic chemotherapy, P04.12 — Newborn affected by maternal cytotoxic drugs, P04.13 — Newborn affected by maternal use of anticonvulsants, P04.14 — Newborn affected by maternal use of opiates, P04.15 — Newborn affected by maternal use of antidepressants, P04.16 — Newborn affected by maternal use of amphetamines, P04.17 — Newborn affected by maternal use of sedative-hypnotics, P04.18 — Newborn affected by other maternal medication, P04.19 — Newborn affected by maternal use of unspecified medication, P04.1A — Newborn affected by maternal use of anxiolytics, +287 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Drug Use with Psychotic Complications, Alcohol Use with Psychotic Complications, Drug Use Disorder, Mild, Uncomplicated, Except Cannabis, Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Newborn affected by maternal conditions or complications of labor/delivery).

P03.3 — Newborn affected by delivery by vacuum extractor [ventouse], P03.4 — Newborn affected by Cesarean delivery, P03.5 — Newborn affected by precipitate delivery, P03.6 — Newborn affected by abnormal uterine contractions, P03.810 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm before the onset of labor, P03.811 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm during labor, P03.819 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm, unspecified as to time of onset, P03.82 — Meconium passage during delivery, P03.89 — Newborn affected by other specified complications of labor and delivery, P03.9 — Newborn affected by complication of labor and delivery, unspecified, P04.1 — Newborn affected by other maternal medication, P04.11 — Newborn affected by maternal antineoplastic chemotherapy, P04.12 — Newborn affected by maternal cytotoxic drugs, P04.13 — Newborn affected by maternal use of anticonvulsants, P04.14 — Newborn affected by maternal use of opiates, P04.15 — Newborn affected by maternal use of antidepressants, P04.16 — Newborn affected by maternal use of amphetamines, P04.17 — Newborn affected by maternal use of sedative-hypnotics, P04.18 — Newborn affected by other maternal medication, P04.19 — Newborn affected by maternal use of unspecified medication, +53 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Newborn”; these codes share that main term but sit in a different category of the Tabular List.

P03.2 — Newborn affected by forceps delivery (affected by, forceps delivery), P03.3 — Newborn affected by delivery by vacuum extractor [ventouse] (affected by, delivery, vacuum extractor), P03.4 — Newborn affected by Cesarean delivery (affected by, Cesarean delivery), P03.5 — Newborn affected by precipitate delivery (affected by, precipitate delivery), P03.6 — Newborn affected by abnormal uterine contractions (affected by, uterine contractions), P03.810 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm before the onset of labor (affected by, heart rate abnormalities, intrauterine, before onset of labor), P03.811 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm during labor (affected by, heart rate abnormalities, intrauterine, during labor), P03.819 — Newborn affected by abnormality in fetal (intrauterine) heart rate or rhythm, unspecified as to time of onset (affected by, heart rate abnormalities, intrauterine), P03.89 — Newborn affected by other specified complications of labor and delivery (affected by, induction of labor), P03.9 — Newborn affected by complication of labor and delivery, unspecified (affected by, delivery), P05.2 — Newborn affected by fetal (intrauterine) malnutrition not light or small for gestational age (affected by, fetal, malnutrition not light or small for gestational age), P05.9 — Newborn affected by slow intrauterine growth, unspecified (affected by, slow intrauterine growth), P08.21 — Post-term newborn (post-term), P08.22 — Prolonged gestation of newborn (prolonged gestation), P28.2 — Cyanotic attacks of newborn (affected by, cyanosis), P28.30 — Primary sleep apnea of newborn, unspecified (apnea, sleep), P28.40 — Unspecified apnea of newborn (apnea), P28.42 — Obstructive apnea of newborn (apnea, obstructive), P28.81 — Respiratory arrest of newborn (affected by, respiratory arrest), P29.11 — Neonatal tachycardia (affected by, heart rate abnormalities, tachycardia), +129 more

Contextual Map

Every relationship of P04.0 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 P04.0 with these 7 related codes in Claim Check

Hierarchy

• P00-P96 — Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96) (P00-P96)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P00-P04 — Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Excludes2

• P04.1 — Newborn affected by other maternal medication[Excludes2]: “newborn affected by other maternal medication (P04.1-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes1 notes

• P93 — Reactions and intoxications due to drugs administered to newborn[Excludes1]: “reactions and intoxications from maternal opiates, tranquilizers and other medication (P04.0-P04.1, P04.4-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• P96.1 — Neonatal withdrawal symptoms from maternal use of drugs of addiction[Excludes1]: “reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• P00 — Newborn affected by maternal conditions that may be unrelated to present pregnancy[Excludes2](via P04.-): “newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• P04.1 — Newborn affected by other maternal medication[Excludes2]: “maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• P04.49 — Newborn affected by maternal use of other drugs of addiction[Excludes2]: “newborn affected by maternal anesthesia and analgesia (P04.0)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• Q86 — Congenital malformation syndromes due to known exogenous causes, not elsewhere classified[Excludes2](via P04.-): “nonteratogenic effects of substances transmitted via placenta or breast milk (P04.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• Z77 — Other contact with and (suspected) exposures hazardous to health[Excludes2](via P04.-): “newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• PNL010 — Newborn affected by maternal conditions or complications of labor/delivery[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications [CMS-HCC]: “Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications — supersedes HCC 138 (Drug Use Disorder, Mild, Uncomplicated, Except Cannabis), HCC 139 (Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications)”— CMS-HCC V28 · 2026

MS-DRG Grouper

• DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS[MS-DRG]: “NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Absorption, chemical, through placenta (newborn), obstetric anesthetic or analgesic drug[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Absorption, drug NEC, through placenta (newborn), obstetric anesthetic or analgesic drug[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), analgesia (maternal)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), anesthesia (maternal)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), opiates, administered for procedures during pregnancy or labor and delivery[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), tranquilizers administered for procedures during pregnancy or labor and delivery[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (25)

• P04 — Newborn affected by noxious substances transmitted via placenta or breast milk[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.1 — Newborn affected by other maternal medication[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.11 — Newborn affected by maternal antineoplastic chemotherapy[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.12 — Newborn affected by maternal cytotoxic drugs[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.13 — Newborn affected by maternal use of anticonvulsants[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.14 — Newborn affected by maternal use of opiates[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.15 — Newborn affected by maternal use of antidepressants[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P04.16 — Newborn affected by maternal use of amphetamines[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 17 more

Change history (2)

• FY2017 — Description revised[Change history]— CMS release files (code change ledger) · icd10cm-fy2017
• and 1 more

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

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release 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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P04.0 in its code family, with their registry titles.

• P04 — Newborn affected by noxious substances transmitted via placenta or breast milk
• P04.1 — Newborn affected by other maternal medication
• P04.11 — Newborn affected by maternal antineoplastic chemotherapy
• P04.12 — Newborn affected by maternal cytotoxic drugs
• P04.13 — Newborn affected by maternal use of anticonvulsants
• P04.14 — Newborn affected by maternal use of opiates
• P04.15 — Newborn affected by maternal use of antidepressants
• P04.16 — Newborn affected by maternal use of amphetamines
• P04.17 — Newborn affected by maternal use of sedative-hypnotics
• P04.18 — Newborn affected by other maternal medication

View all codes in the P04 family