Perinatal / Newborn Diagnoses (Age 0) ICD-10-CM
The perinatal / newborn diagnoses edit is a check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 42 ICD-10-CM diagnosis codes listed below. These conditions occur only during the perinatal or newborn period, so reporting one for a patient older than 0 makes the MCE flag the claim as an age conflict.
Diagnosis Codes in This Edit 42 codes · 7 categories
A33 Tetanus neonatorum1 code
- A33 Tetanus neonatorum
E84 Cystic fibrosis1 code
- E84.11 Meconium ileus in cystic fibrosis
H04 Disorders of lacrimal system4 codes
N47 Disorders of prepuce1 code
- N47.0 Adherent prepuce, newborn
Z00 Encounter for general examination without complaint, suspected or reported diagnosis2 codes
Z05 Encounter for observation and evaluation of newborn for suspected diseases and conditions ruled out15 codes
- Z05.0 Observation and evaluation of newborn for suspected cardiac condition ruled out
- Z05.1 Observation and evaluation of newborn for suspected infectious condition ruled out
- Z05.2 Observation and evaluation of newborn for suspected neurological condition ruled out
- Z05.3 Observation and evaluation of newborn for suspected respiratory condition ruled out
- Z05.41 Observation and evaluation of newborn for suspected genetic condition ruled out
- Z05.42 Observation and evaluation of newborn for suspected metabolic condition ruled out
- Z05.43 Observation and evaluation of newborn for suspected immunologic condition ruled out
- Z05.5 Observation and evaluation of newborn for suspected gastrointestinal condition ruled out
- Z05.6 Observation and evaluation of newborn for suspected genitourinary condition ruled out
- Z05.71 Observation and evaluation of newborn for suspected skin and subcutaneous tissue condition ruled out
- Z05.72 Observation and evaluation of newborn for suspected musculoskeletal condition ruled out
- Z05.73 Observation and evaluation of newborn for suspected connective tissue condition ruled out
- Z05.81 Observation and evaluation of newborn for suspected condition related to home physiologic monitoring device ruled out
- Z05.89 Observation and evaluation of newborn for other specified suspected condition ruled out
- Z05.9 Observation and evaluation of newborn for unspecified suspected condition ruled out
Z38 Liveborn infants according to place of birth and type of delivery18 codes
- Z38.00 Single liveborn infant, delivered vaginally
- Z38.01 Single liveborn infant, delivered by cesarean
- Z38.1 Single liveborn infant, born outside hospital
- Z38.2 Single liveborn infant, unspecified as to place of birth
- Z38.30 Twin liveborn infant, delivered vaginally
- Z38.31 Twin liveborn infant, delivered by cesarean
- Z38.4 Twin liveborn infant, born outside hospital
- Z38.5 Twin liveborn infant, unspecified as to place of birth
- Z38.61 Triplet liveborn infant, delivered vaginally
- Z38.62 Triplet liveborn infant, delivered by cesarean
- Z38.63 Quadruplet liveborn infant, delivered vaginally
- Z38.64 Quadruplet liveborn infant, delivered by cesarean
- Z38.65 Quintuplet liveborn infant, delivered vaginally
- Z38.66 Quintuplet liveborn infant, delivered by cesarean
- Z38.68 Other multiple liveborn infant, delivered vaginally
- Z38.69 Other multiple liveborn infant, delivered by cesarean
- Z38.7 Other multiple liveborn infant, born outside hospital
- Z38.8 Other multiple liveborn infant, unspecified as to place of birth
Questions About This Code Edit
What is the perinatal / newborn diagnoses Medicare code edit?
The Medicare Code Editor detects inconsistencies in perinatal / newborn cases by checking a patient's age and any diagnosis on the patient's record. The newborn code edits apply to patients age 0 years only; a subset of diagnoses which will only occur during the perinatal or newborn period of age 0 (e.g., tetanus neonatorum, health examination for newborn under 8 days old). Claims that fail the check are flagged for correction before payment.
How many ICD-10-CM codes are on the perinatal / newborn diagnoses list?
The FY 2026 list contains 42 diagnosis codes across 7 code categories, imported from the CMS Definitions of Medicare Code Edits v43.0.
What happens when a claim triggers this edit?
These conditions occur only during the perinatal or newborn period, so reporting one for a patient older than 0 makes the MCE flag the claim as an age conflict.
Does this edit make the codes invalid for billing?
No. Every code on this list is a valid ICD-10-CM code. The edit checks how the code is used on the claim, not whether the code exists.
Other ICD-10-CM Medicare Code Edits
Source: CMS Definitions of Medicare Code Edits v43.0, effective October 1, 2025 through September 30, 2026. Code lists are imported directly from the official manual. See also the ICD-10-PCS procedure edits and the MS-DRG list.
