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ICD-10/P04.49

P04.49 ICD-10-CM Code: Newborn affected by maternal use of other drugs of addiction

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

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, 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.

Official Registry Overview & Definition

Newborn affected by maternal use of other drugs of addiction is a billable ICD-10-CM diagnosis code (P04.49).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for P04.49 in the official ICD-10-CM tabular list.

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

Change history

  • FY2017 — 2016-10-01
    Description revised
    Newborn (suspected to be) affected by maternal use of other drugs of addiction → Newborn affected by maternal use of other drugs of addiction
    FY2017 changes
  • FY2017 — 2016-10-01
    Short description revised
    Newborn affected by maternal use of drugs of addiction → Newborn affected by maternal use of other drugs of addiction
    FY2017 changes

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.

Contextual Map

Every relationship of P04.49 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.

Hierarchy

  • P00-P96 — Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96) (P00-P96) [Hierarchy]
  • P00-P04 — Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery [Hierarchy]

Excludes2

  • P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery [Excludes2]: “newborn affected by maternal anesthesia and analgesia (P04.0)” · check together
  • P96.1 — Neonatal withdrawal symptoms from maternal use of drugs of addiction [Excludes2]: “withdrawal symptoms from maternal use of drugs of addiction (P96.1)” · check together

Referenced by Excludes1 notes

  • P93 — Reactions and intoxications due to drugs administered to newborn [Excludes1](via P04.4.-): “reactions and intoxications from maternal opiates, tranquilizers and other medication (P04.0-P04.1, P04.4-)” · check together

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.-)” · check together
  • P04.1 — Newborn affected by other maternal medication [Excludes2](via P04.4.-): “maternal use of drugs of addiction (P04.4-)” · check together
  • 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.-)” · check together
  • 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.-)” · check together

Clinical classification (CCSR)

  • PNL014 — Neonatal abstinence syndrome [CCSR]
  • PNL010 — Newborn affected by maternal conditions or complications of labor/delivery [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)”

Potential MS-DRG

  • DRG 794 — NEONATE WITH OTHER SIGNIFICANT PROBLEMS [MS-DRG]: “NEONATE WITH OTHER SIGNIFICANT PROBLEMS (MDC 15)”

MDC crossing · procedures

  • 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.”

Index entries

  • Absorption, drug NEC, addictive, through placenta (newborn), specified drug NEC[Index term]
  • Newborn (infant) (liveborn) (singleton), affected by, drugs of addiction, specified drug NEC[Index term]
  • Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), drugs NEC (addictive) (illegal)[Index term]
  • Newborn (infant) (liveborn) (singleton), affected by, methamphetamine (s)[Index term]

Nearest codes (25)

  • P04 — Newborn affected by noxious substances transmitted via placenta or breast milk [Sibling]
  • P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery [Sibling]
  • P04.1 — Newborn affected by other maternal medication [Sibling]
  • P04.11 — Newborn affected by maternal antineoplastic chemotherapy [Sibling]
  • P04.12 — Newborn affected by maternal cytotoxic drugs [Sibling]
  • P04.13 — Newborn affected by maternal use of anticonvulsants [Sibling]
  • P04.14 — Newborn affected by maternal use of opiates [Sibling]
  • P04.15 — Newborn affected by maternal use of antidepressants [Sibling]
  • and 17 more

Change history (2)

  • FY2017 — Description revised [Change history]
  • and 1 more

Referenced by Other Codes

Clinical classification (AHRQ CCSR):PNL014 — Neonatal abstinence syndrome (default); PNL010 — Newborn affected by maternal conditions or complications of labor/delivery.

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

Potential MS-DRG Relationships (FY2026)

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.

Official ICD-10-CM tabular notes on other codes that name P04.49 or its code family.

1 Excludes1 notes: P93 (via P04.4.-).

4 Excludes2 notes across 3 chapters: P00 (via P04.-), P04.1 (via P04.4.-), Q86 (via P04.-), Z77 (via P04.-).

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P04.49 in its code family, with their registry titles.

  • P04.3 — Newborn affected by maternal use of alcohol
  • P04.4 — Newborn affected by maternal use of drugs of addiction
  • 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
  • P04.5 — Newborn affected by maternal use of nutritional chemical substances
  • P04.6 — Newborn affected by maternal exposure to environmental chemical substances
  • P04.8 — Newborn affected by other maternal noxious substances
  • P04.81 — Newborn affected by maternal use of cannabis
  • P04.89 — Newborn affected by other maternal noxious substances

View all codes in the P04 family

Indexed Clinical Terms (4)

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code.

  • Absorption, drug NEC, addictive, through placenta (newborn), specified drug NEC
  • Newborn (infant) (liveborn) (singleton), affected by, drugs of addiction, specified drug NEC
  • Newborn (infant) (liveborn) (singleton), affected by, maternal (complication of) (use of), drugs NEC (addictive) (illegal)
  • Newborn (infant) (liveborn) (singleton), affected by, methamphetamine (s)