2026 ICD-10-CM Diagnosis Code P04.0Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
P04.0 is a billable ICD-10-CM diagnosis code for newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 794. Coders also document this condition as early neonatal disorder caused by maternal analgesia transmitted via placenta during labor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Newborn affected by maternal conditions or complications of labor/delivery.
For Medicare Advantage risk adjustment, P04.0 maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications) under the V28 model, adding a risk factor of about 0.424 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
P04.0 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Early neonatal disorder caused by maternal analgesia transmitted via placenta during labor
- Early neonatal disorder caused by maternal anesthesia transmitted via placenta during labor
- Early neonatal disorder caused by maternal general anesthesia transmitted via placenta
- Early neonatal disorder caused by maternal meperidine via placenta during labor
- Early neonatal disorder caused by maternal tranquilizer via placenta during labor
- Early neonatal disorder due to maternal epidural anesthesia during labor
- Neonatal disorder caused by maternal analgesia transmitted via breast milk
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Inclusion Terms
- Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery
Type 2 Excludes
- newborn affected by other maternal medication P04.1
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Convert P04.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About P04.0Overview
Is P04.0 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does P04.0 group to?
When newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery is the principal diagnosis on an inpatient stay, it groups to MS-DRG 794 (neonate with Other Significant Problems), which carries a relative weight of 1.4759. Higher weights mean higher Medicare reimbursement.
What is the ICD-9 equivalent of P04.0?
Under the General Equivalence Mappings, newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery converts to ICD-9-CM 763.5 (mat anesth/analg aff NB). The mapping is a direct match.
What HCC is P04.0?
P04.0 (newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery) maps to CMS-HCC Category 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications), commonly written as HCC 137, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It does not map to any RxHCC in the Part D prescription drug model.
Does P04.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, P04.0 adds a risk adjustment factor of about 0.424 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.297 to 0.502 depending on the payment segment). A more severe related category (HCC 135 and HCC 136) supersedes it when both are reported. See the full factor table on the HCC 137 category page.
