Is P04.3 a billable ICD-10-CM code?

Yes. P04.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does P04.3 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).

What cannot be coded together with P04.3?

P04.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

P04.3

P04.3 — Newborn affected by maternal use of alcohol

Billable / specific codeICD-10-CM

P04.3 is a billable, specific ICD-10-CM code for newborn affected by maternal use of alcohol. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

fetal alcohol syndrome (Q86.0)

Risk adjustment

P04.3 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.

Medicare coverage

P04.3 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57189Billing and Coding: Serum Magnesium

How P04.3 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 P04.3.

Newborn›affected by›maternal›alcohol

Related codes at this level

Codes that share P04. If P04.3 is not quite right, the correct code is usually one of these.

Questions about P04.3

Is P04.3 a billable ICD-10-CM code?: Yes. P04.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does P04.3 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).
What cannot be coded together with P04.3?: P04.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.