ICD-10 · PDGM grouping
P04 Newborn affected by noxious substances transmitted via placenta or breast milk
All 22 codes in the P04 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
22
Can lead a claim
10
Cannot lead a claim
12
What CMS assigns to P04
10 of the 22 codes group to MMTA - Other; 12 are assigned no clinical group. None of the 22 is assigned a comorbidity subgroup. 10 of the 22 can lead a claim. CMS attaches a code-first note to all 22.
Code first
CMS grouper convention 12, on P04.0, P04.2, P04.3, P04.40, P04.41, P04.42, P04.49, P04.5, P04.6, P04.81, P04.89, P04.9. Code first:
- underlying disease
CMS grouper convention 148, on P04.11, P04.12, P04.13, P04.14, P04.15, P04.16, P04.17, P04.1A, P04.18, P04.19. Code first:
- , if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)
- any current condition in newborn, if applicable
- withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)
Every code in P04
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| P04.0 | Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and deliveryCMS: NB aff by matern anesth and analgesia in preg, labor and del | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.1 Newborn affected by other maternal medication | ||||
| P04.11 | Newborn affected by maternal antineoplastic chemotherapy | Can lead a claim, code first applies | A | None |
| P04.12 | Newborn affected by maternal cytotoxic drugs | Can lead a claim, code first applies | A | None |
| P04.13 | Newborn affected by maternal use of anticonvulsants | Can lead a claim, code first applies | A | None |
| P04.14 | Newborn affected by maternal use of opiates | Can lead a claim, code first applies | A | None |
| P04.15 | Newborn affected by maternal use of antidepressants | Can lead a claim, code first applies | A | None |
| P04.16 | Newborn affected by maternal use of amphetamines | Can lead a claim, code first applies | A | None |
| P04.17 | Newborn affected by maternal use of sedative-hypnotics | Can lead a claim, code first applies | A | None |
| P04.1A | Newborn affected by maternal use of anxiolytics | Can lead a claim, code first applies | A | None |
| P04.18 | Newborn affected by other maternal medication | Can lead a claim, code first applies | A | None |
| P04.19 | Newborn affected by maternal use of unspecified medication | Can lead a claim, code first applies | A | None |
| P04.2 | Newborn affected by maternal use of tobacco | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.3 | Newborn affected by maternal use of alcohol | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.4 Newborn affected by maternal use of drugs of addiction | ||||
| P04.40 | Newborn affected by maternal use of unspecified drugs of addictionCMS: Newborn affected by maternal use of unsp drugs of addiction | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.41 | Newborn affected by maternal use of cocaine | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.42 | Newborn affected by maternal use of hallucinogens | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.49 | Newborn affected by maternal use of other drugs of addiction | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.5 | Newborn affected by maternal use of nutritional chemical substancesCMS: Newborn aff by maternal use of nutritional chemical substnc | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.6 | Newborn affected by maternal exposure to environmental chemical substancesCMS: Newborn aff by maternal exposure to environ chemical substnc | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.8 Newborn affected by other maternal noxious substances | ||||
| P04.81 | Newborn affected by maternal use of cannabis | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.89 | Newborn affected by other maternal noxious substances | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| P04.9 | Newborn affected by maternal noxious substance, unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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