ICD-10 P35.4
Billable / Specific MCCCongenital Zika virus disease
About ICD-10-CM P35.4
ICD-10-CM code P35.4 represents Congenital Zika virus disease. This is a billable/specific code in the Perinatal Period chapter (block P35). The 2026 edition of ICD-10-CM P35.4 became effective on October 1, 2025.
Coding Tips for P35.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
P35.4 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Use Additional Code
When coding P35.4, also report these additional codes when applicable.
- code to identify manifestations of congenital Zika virus disease
Inpatient DRG Impact, MCC
codes Congenital Zika virus disease. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for P35.4
Local Coverage Determinations (LCDs) from CMS MACs that list P35.4 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 P35.4.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but P35.4 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with P35.4
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.
Codes Adjacent To P35.4
Other codes in section P35-P39 (Infections specific to the perinatal period).
ICD-10 P35.4, Billing FAQ
Is ICD-10 code P35.4 billable? +
Yes, P35.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is P35.4 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
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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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