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P04.1 ICD-10-CM Code: Newborn affected by other maternal medication

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 · 2 Excludes1 · 6 Excludes2 · 3 code-first instructions

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P04.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on P04.1 itself; “inherited from” names the category or block whose note applies here.

Includes

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

  • nonteratogenic effects of substances transmitted via placenta

Source: inherited from P04

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

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.

  • 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)
  • any current condition in newborn, if applicable inherited from P04

Coder workflow for P04.1

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

Before you code P04.1

  1. P04.1 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).

    ReviewP04.11, P04.12, P04.13, P04.14, P04.15, P04.16, P04.17, P04.18, P04.19, P04.1A

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

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with P04.1. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

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

    ReviewP04.11, P04.12, P04.13, P04.14, P04.15, P04.16, P04.17, P04.18, P04.19, P04.1A

  2. Does the documentation support a condition named in P04.1’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewQ86.2, Q86.1

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

    ReviewP96.1, P96.2

Consider P04.1. 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

  • Excludes1 — check before selecting P04.1(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with P04.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareQ86.2, Q86.1

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

  • Excludes2 — not part of P04.1(6 notes)

    Coding workflow: The conditions named in this note are not included in P04.1. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareP04.0, P04.4, Z05, P58.4, Z77

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

  • Code First — sequencing check(3 notes)

    Coding workflow: Check whether the underlying or etiologic condition the note names is documented. When it is, sequence it before P04.1. Do not add an underlying condition the record does not document.

    ReviewP96.1, P96.2

    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: Both the condition P04.1 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewQ86.2, Q86.1

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).

ReviewP96.1, P96.2

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 other maternal medication is a non-billable ICD-10-CM category code (P04.1). 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.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. Sequencing: 3 Code First instructions — the underlying condition is sequenced before this code when present. See the Code First notes
  2. 2 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 6 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

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 P04.1 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 1 Excludes1 note: P93 — Reactions and intoxications due to drugs administered to newborn.

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.-), P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery, P04.42 — Newborn affected by maternal use of hallucinogens, 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.

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 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).

P03.4 — 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, P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery, 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, +53 more

Contextual Map

Every relationship of P04.1 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 P04.1 with these 11 related codes in Claim Check

Hierarchy

Excludes1

Excludes2

Code First

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

Nearest codes (25)

Change history (4)

Common coding questions

Can P04.1 be billed directly?

No. P04.1 (Newborn affected by other maternal medication) 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

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "P04.1 — Newborn affected by other maternal medication." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/p04.1-newborn-affected-by-other-maternal-medication

Change history

  • FY2019 — October 1, 2018
    Became a non-billable header
    FY2019 changes
  • FY2017 — October 1, 2016
    Description revised
    Newborn (suspected to be) affected by other maternal medication → Newborn affected by other maternal medication
    FY2017 changes
  • FY2017 — October 1, 2016
    Short description revised
    Newborn affected by oth maternal medication → Newborn affected by other maternal medication
    FY2017 changes
  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Newborn (suspected to be) affected by other maternal medication

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P04.1 in its code family, with their registry titles.

View all codes in the P04 family