ICD-10 P04.1
Non-Billable HeaderNewborn affected by other maternal medication
About ICD-10-CM P04.1
ICD-10-CM code P04.1 represents Newborn affected by other maternal medication. This is a non-billable header code in the Perinatal Period chapter (block P04). The 2026 edition of ICD-10-CM P04.1 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Type 1 Excludes
Pure excludes, these codes can never be coded together with P04.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- dysmorphism due to warfarin (Q86.2)
- fetal hydantoin syndrome (Q86.1)
Type 2 Excludes
Not included here, the excluded code is not part of P04.1, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)
- maternal use of drugs of addiction (P04.4-)
Coding Notes
Code First
- , if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
- withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)
Medicare LCD Coverage for P04.1
Local Coverage Determinations (LCDs) from CMS MACs that list P04.1 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing P04.1.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but P04.1 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with P04.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert P04.1 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| P04.1 | 76074 | 10000 |
| P04.1 | 76078 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To P04.1
Other codes in section P00-P04 (Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery).
ICD-10 P04.1, Billing FAQ
Is ICD-10 code P04.1 billable? +
No, P04.1 is a non-billable header code. Use a more specific child code from block P04 when submitting claims.
What codes are Type 1 Excludes for P04.1? +
Type 1 Excludes (never code together with P04.1): dysmorphism due to warfarin (Q86.2); fetal hydantoin syndrome (Q86.1)
What codes are Type 2 Excludes for P04.1? +
Type 2 Excludes (may be coded together when both conditions exist): maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0); maternal use of drugs of addiction (P04.4-)
What ICD-9 codes does P04.1 map to? +
Per CMS GEMs, P04.1 maps to ICD-9 codes: 76074, 76078. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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