P03.4 ICD-10-CM Code: Newborn affected by Cesarean delivery
HCC Buddy Code Card
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FY 2026 Apr update / Certain conditions originating in the perinatal period (P00-P96) / Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (P00-P04)
P03.4
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNewborn affected by Cesarean delivery
A newborn baby was affected by complications related to delivery by Cesarean section (surgical delivery through an abdominal incision).
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for P03.4 in this effective period.
Excludes 2
Official- encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for P03.4 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for P03.4 in this effective period.
Code First
Official- any current condition in newborn
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for P03.4 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for P03.4 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is P03.4 an HCC code?
No. P03.4 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- P03.4
- Description
- Newborn affected by Cesarean delivery
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
P03.4 is the ICD-10-CM diagnosis code for newborn affected by cesarean delivery. A newborn baby was affected by complications related to delivery by Cesarean section (surgical delivery through an abdominal incision). P03.4 sits in the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96), within the section covering newborn affected by maternal factors and by complications of pregnancy, labor, and delivery (p00-p04).
P03.4 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document whether the Cesarean was planned (elective) or emergency, as this may affect clinical outcomes.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P03.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the Cesarean was planned (elective) or emergency, as this may affect clinical outcomes
- •This code captures the effect on the newborn; maternal complications are coded separately