Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesNewborn affected by maternal factors and by complications of pregnancy, labor, and deliveryICD-10-CM p04-newborn-affected-by-noxious-substances
    Ask Trek AI about this page

    ICD-10-CM Code For Newborn Affected By Noxious Substances Transmitted Via Placenta Or Breast Milk: Group Overview

    The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group P04 includes conditions in which a newborn is affected by noxious substances transmitted from the mother via the placenta or through breast milk, such as drugs, alcohol, and other toxic agents. These ICD-10-CM diagnosis codes are used to document neonatal exposure and its clinical effects, capturing the presence of substance-related complications and organ system involvement. Accurate coding within the ICD-10-CM P04 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

    Customize your policy alerts

    Sign up for ICD-10-CM Code For Newborn Affected By Noxious Substances Transmitted Via Placenta Or Breast Milk: Group Overview policy alerts

    Get alerted when relevant policies change without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    ICD-10-CM P04: Newborn Affected By Noxious Substances Transmitted Via Placenta Or Breast Milk Overview

    This code group covers newborns affected by harmful substances passed from the mother to the infant via the placenta or breast milk, including drugs, alcohol, and other toxic agents. It targets conditions present at birth that result from prenatal or lactational exposure and can affect multiple organ systems, particularly the nervous and respiratory systems. Accurate coding matters for clinical records, epidemiology, and appropriate reimbursement for neonatal care related to maternal exposures.

    Table of contents

    Progress1 / 6

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    When to Use

    Use a code from this group when a newborn has documented exposure to noxious substances transmitted via the placenta or breast milk and presents with signs or effects related to that exposure. Select the specific code that reflects the substance involved and any associated clinical manifestations when documented in the medical record.

    ICD-10-CM Codes

    22 rows

    ICD-10-CM CodeDescription
    P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
    P04.11Newborn affected by maternal antineoplastic chemotherapy
    P04.12Newborn affected by maternal cytotoxic drugs
    P04.13Newborn affected by maternal use of anticonvulsants
    P04.14Newborn affected by maternal use of opiates
    P04.15Newborn affected by maternal use of antidepressants
    P04.16Newborn affected by maternal use of amphetamines
    P04.17Newborn affected by maternal use of sedative-hypnotics
    P04.18Newborn affected by other maternal medication
    P04.19Newborn affected by maternal use of unspecified medication
    P04.1ANewborn affected by maternal use of anxiolytics
    P04.2Newborn affected by maternal use of tobacco
    P04.3Newborn affected by maternal use of alcohol
    P04.40Newborn affected by maternal use of unspecified drugs of addiction
    P04.41Newborn affected by maternal use of cocaine
    P04.42Newborn affected by maternal use of hallucinogens
    P04.49Newborn affected by maternal use of other drugs of addiction
    P04.5Newborn affected by maternal use of nutritional chemical substances
    P04.6Newborn affected by maternal exposure to environmental chemical substances
    P04.81Newborn affected by maternal use of cannabis

    Showing 1–20 of 22

    DRG Codes

    1 rows

    DRG CodeDescription
    794Neonate with Other Significant Problems

    Typical Clinical Scenarios

    • A term newborn born after an uncomplicated vaginal delivery is noted to have jitteriness, poor feeding, and mild respiratory distress within hours of birth; the mother received methadone maintenance therapy during pregnancy and routine toxicology of the infant is positive for opioids. The infant is admitted to the newborn nursery for observation and supportive care for neonatal withdrawal and effects from in utero opioid exposure, so a code from this group indicating exposure to narcotics and withdrawal is assigned. Typical codes: P04.14, P04.15
    • A premature neonate on day two of life develops apnea and poor weight gain; maternal records show high-dose corticosteroid therapy and recent chemotherapy during pregnancy. Because the infant’s signs are attributed to exposure to maternal medications and potential immunosuppressive effects transmitted via the placenta, the newborn receives monitoring and interventions for adverse effects of maternal drug therapy and an appropriate exposure code is assigned. Typical codes: P04.41, P04.49
    • A newborn in the NICU has feeding intolerance and recurrent vomiting after the mother was found to be breastfeeding while using alcohol and nicotine; the clinical team documents intoxication effects in the infant related to substances transmitted through breast milk. The infant is managed for feeding difficulties and observation for toxic effects from breast milk exposure, prompting assignment of a code from this group specifying exposure via breast milk. Typical codes: P04.11, P04.12

    Related Codes

    P00-NEWBORN-AFFECTED-BY-MATERNAL-CONDITIONS

    ICD-10-CM Code For Newborn Affected By Maternal Conditions That May Be Unrelated To Present Pregnancy: Group Overview

    P01-NEWBORN-AFFECTED-BY-MATERNAL-COMPLICATIONS

    ICD-10-CM Code For Newborn Affected By Maternal Complications Of Pregnancy: Group Overview

    P02-NEWBORN-AFFECTED-BY-PLACENTA-CORD-MEMBRANES

    ICD-10-CM Code For Newborn Affected By Complications Of Placenta Cord And Membranes: Group Overview

    P03-NEWBORN-OTHER-DELIVERY-COMPLICATIONS

    ICD-10-CM Code For Newborn Affected By Other Complications Of Labor And Delivery: Group Overview

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.