Is P04.0 a billable ICD-10-CM code?

Yes. P04.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does P04.0 sit in the tabular list?

Certain conditions originating in the perinatal period (P00-P96), in the block Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04).

P04.0

P04.0 — Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery

Billable / specific codeICD-10-CM

P04.0 is a billable, specific ICD-10-CM code for newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery. It is valid for submission on a claim.

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

newborn affected by other maternal medication (P04.1-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery

Other codes that can never be billed with P04.0

These codes carry an Excludes1 note pointing at P04.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P04.0 alone.

P93Reactions and intoxications due to drugs administered to newborn
P96.1Neonatal withdrawal symptoms from maternal use of drugs of addiction

Risk adjustment

P04.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications0.424 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

How P04.0 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to P04.0.

Absorption›chemical›through placenta›obstetric anesthetic or analgesic drug
Absorption›drug NEC›through placenta›obstetric anesthetic or analgesic drug
Newborn›affected by›maternal›analgesia(maternal)
Newborn›affected by›maternal›anesthesia(maternal)
Newborn›affected by›maternal›tranquilizers administered for procedures during pregnancy or labor and delivery
Newborn›affected by›maternal›opiates›administered for procedures during pregnancy or labor and delivery

Related codes at this level

Codes that share P04. If P04.0 is not quite right, the correct code is usually one of these.

Questions about P04.0

Is P04.0 a billable ICD-10-CM code?: Yes. P04.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does P04.0 sit in the tabular list?: Certain conditions originating in the perinatal period (P00-P96), in the block Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04).