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P04.18 ICD-10-CM Code: Newborn affected by other maternal medication

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 2 Excludes1 · 6 Excludes2 · 3 code-first instructions
Risk adjustment
CMS-HCC V28: 1 category

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (supersedes HCC 138, HCC 139)

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P04.18 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on P04.18 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).

Source: inherited from P04.1

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) inherited from P04.1
  • withdrawal symptoms from therapeutic use of drugs in newborn (P96.2) inherited from P04.1
  • any current condition in newborn, if applicable inherited from P04

Coder workflow for P04.18

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

Before you code P04.18

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with P04.18. 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 a condition named in P04.18’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

  2. Is the underlying (etiologic) condition the Code First note names documented?
    Yes → Sequence the underlying condition first, then P04.18.
    No → Continue; do not add an underlying condition the record does not document.

    ReviewP96.1, P96.2

Consider P04.18. 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 P04.18(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with P04.18: 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 P04.18(6 notes)

    Coding workflow: The conditions named in this note are not included in P04.18. 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 P04.18. 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 P04.18 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.

Coding context

The comparisons, hierarchy, index entries, guidelines, relationships, risk-adjustment and coverage context a coder commonly needs. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Don’t confuse P04.18 with…

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

The codes most likely to be picked instead of P04.18 — 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.

  • Q86.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of dysmorphism due to warfarin moves the case to Q86.2; the two are not reported together unless documented as unrelated.

    Full comparison: P04.18 vs Q86.2 →

  • Q86.1— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of fetal hydantoin syndrome moves the case to Q86.1; the two are not reported together unless documented as unrelated.

    Full comparison: P04.18 vs Q86.1 →

  • P04.19— 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 use of unspecified medication” takes P04.19; specificity in the record moves it back here.

    Full comparison: P04.18 vs P04.19 →

  • P04.0— 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 maternal anesthesia and analgesia in pregnancy, labor and delivery adds P04.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: P04.18 vs P04.0 →

  • P04.4— 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 maternal use of drugs of addiction adds P04.4; it is not part of this code and both may be reported when both are documented.

    Full comparison: P04.18 vs P04.4 →

  • 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: P04.18 vs Q00 →

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.

Code Overview

Newborn affected by other maternal medication is a billable ICD-10-CM diagnosis code (P04.18).

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

Indexed Clinical Terms (1)

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.

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

  • 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 P04.18 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 (via P04.1.-), P04.42 — Newborn affected by maternal use of hallucinogens (via P04.1.-), 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 (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

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.

F19.988 — Other psychoactive substance use, unspecified with other psychoactive substance-induced disorder, F19.99 — Other psychoactive substance use, unspecified with unspecified psychoactive substance-induced disorder, P04.0 — 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, P04.19 — Newborn affected by maternal use of unspecified medication, P04.1A — Newborn affected by maternal use of anxiolytics, P04.2 — Newborn affected by maternal use of tobacco, P04.3 — Newborn affected by maternal use of alcohol, P04.40 — Newborn affected by maternal use of unspecified drugs of addiction, P04.41 — Newborn affected by maternal use of cocaine, P04.42 — Newborn affected by maternal use of hallucinogens, P04.49 — Newborn affected by maternal use of other drugs of addiction, P04.5 — Newborn affected by maternal use of nutritional chemical substances, P04.6 — Newborn affected by maternal exposure to environmental chemical substances, +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).

P03.9 — Newborn affected by complication of labor and delivery, unspecified, P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery, P04.1 — 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, P04.19 — Newborn affected by maternal use of unspecified medication, P04.1A — Newborn affected by maternal use of anxiolytics, P04.2 — Newborn affected by maternal use of tobacco, P04.3 — Newborn affected by maternal use of alcohol, P04.40 — Newborn affected by maternal use of unspecified drugs of addiction, P04.41 — Newborn affected by maternal use of cocaine, P04.42 — Newborn affected by maternal use of hallucinogens, P04.49 — Newborn affected by maternal use of other drugs of addiction, P04.5 — Newborn affected by maternal use of nutritional chemical substances, P04.6 — Newborn affected by maternal exposure to environmental chemical substances, +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), +127 more

Contextual Map

Every relationship of P04.18 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 P04.18 with these 6 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Clinical classification (CCSR)

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

MDC crossing

Index entries

  • Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), medication, specified type NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (25)

Change history

Deep reference

Published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

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

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. "P04.18 — Newborn affected by other maternal medication." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/p04.18-newborn-affected-by-other-maternal-medication

Change history

  • FY2019 — October 1, 2018
    Added to the code set
    Newborn affected by other maternal medication
    FY2019 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P04.18 in its code family, with their registry titles.

View all codes in the P04 family