Is P96.1 a billable ICD-10-CM code?

Yes. P96.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does P96.1 sit in the tabular list?

Certain conditions originating in the perinatal period (P00-P96), in the block Other disorders originating in the perinatal period (P90-P96).

What cannot be coded together with P96.1?

P96.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

P96.1

P96.1 — Neonatal withdrawal symptoms from maternal use of drugs of addiction

Billable / specific codeICD-10-CM

P96.1 is a billable, specific ICD-10-CM code for neonatal withdrawal symptoms from maternal use of drugs of addiction. 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.

reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)

Inclusion terms

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

Drug withdrawal syndrome in infant of dependent mother
Neonatal abstinence syndrome

Other codes that can never be billed with P96.1

These codes carry an Excludes1 note pointing at P96.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading P96.1 alone.

P93Reactions and intoxications due to drugs administered to newborn

Risk adjustment

P96.1 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 P96.1 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 P96.1.

Abstinence symptoms, syndrome›neonatal
Newborn›abstinence syndrome
Syndrome›abstinence, neonatal
Syndrome›drug withdrawal, infant of dependent mother
Syndrome›neonatal abstinence
Newborn›affected by›neonatal abstinence syndrome
Withdrawal state›newborn›infant of dependent mother
Dependence›drug NEC›cocaine›withdrawal symptoms in newborn
Reaction›drug NEC›withdrawal›infant of dependent mother
Reaction›drug NEC›withdrawal›newborn
Syndrome›withdrawal›drug›infant of dependent mother

Related codes at this level

Codes that share P96. If P96.1 is not quite right, the correct code is usually one of these.

Questions about P96.1

Is P96.1 a billable ICD-10-CM code?: Yes. P96.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does P96.1 sit in the tabular list?: Certain conditions originating in the perinatal period (P00-P96), in the block Other disorders originating in the perinatal period (P90-P96).
What cannot be coded together with P96.1?: P96.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.