What is ICD-10 code P04.13?

P04.13 is the ICD-10-CM diagnosis code for Newborn affected by maternal use of anticonvulsants. The newborn was exposed to seizure-preventing medications taken by the mother during pregnancy. It belongs to the ICD-10-CM chapter for certain conditions originating in the perinatal period (p00-p96). P04.13 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. P04.13 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. P04.13 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. P04.13 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does P04.13 map to under V28?

P04.13 maps to CMS-HCC V28 HCC 137 (Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM P04.13: Newborn affected

P04.13 maps to CMS-HCC V28 137. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupP04.13

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

P04.13

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Newborn affected by maternal use of anticonvulsants

The newborn was exposed to seizure-preventing medications taken by the mother during pregnancy.

Buddy Insight

Maternal anticonvulsant use during pregnancy can cause specific teratogenic effects including neural tube defects, cardiac malformations, and characteristic facial features in newborns.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 137

Drug Use Disorder, Moderate/S...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

P04Newborn affected by noxious substances transmitted via placenta or breast milk P04.1Newborn affected by other maternal medication P04.13Newborn affected by maternal use of anticonvulsants

Inclusion Terms

Official

No inclusion terms are included in this display for P04.13. Check the code and parent instructions in the Code Book.

Excludes 2

Official

congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from P00-P96, P04, P04.1
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from P00-P96, P04, P04.1
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from P00-P96, P04, P04.1
neoplasms (C00-D49)Inherited from P00-P96, P04, P04.1
tetanus neonatorum (A33)Inherited from P00-P96, P04, P04.1
congenital malformations (Q00-Q99)Inherited from P00-P96, P04, P04.1
encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)Inherited from P00-P96, P04, P04.1
neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)Inherited from P00-P96, P04, P04.1
newborn in contact with and (suspected) exposures hazardous to health not transmitted via placenta or breast milk (Z77.-)Inherited from P00-P96, P04, P04.1
maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0)Inherited from P00-P96, P04, P04.1
maternal use of drugs of addiction (P04.4-)Inherited from P00-P96, P04, P04.1

Related Codes

Official

P04.11Newborn affected by maternal antineoplastic chemotherapy P04.12Newborn affected by maternal cytotoxic drugs P04.14Newborn affected by maternal use of opiates P04.15Newborn affected by maternal use of antidepressants P04.16Newborn affected by maternal use of amphetamines

Includes

Official

conditions that have their origin in the fetal or perinatal period (before birth through the first 28 days after birth) even if morbidity occurs laterInherited from P00-P96, P04
nonteratogenic effects of substances transmitted via placentaInherited from P00-P96, P04

Excludes 1

Official

dysmorphism due to warfarin (Q86.2)Inherited from P04.1
fetal hydantoin syndrome (Q86.1)Inherited from P04.1

Code First

Official

any current condition in newborn, if applicableInherited from P04, P04.1
, if applicable, withdrawal symptoms from maternal use of drugs of addiction (P96.1)Inherited from P04, P04.1
withdrawal symptoms from therapeutic use of drugs in newborn (P96.2)Inherited from P04, P04.1

Use Additional

Official

No Use Additional Code instructions are included in this display for P04.13. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for P04.13. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of maternal anticonvulsant medication use

Specific anticonvulsant agents taken during pregnancy

Dosage and duration of maternal treatment

Clinical features suggestive of anticonvulsant effects

MEAT Support

HCC Buddy guidance

Documentation of maternal anticonvulsant medication use

Specific anticonvulsant agents taken during pregnancy

Dosage and duration of maternal treatment

Clinical features suggestive of anticonvulsant effects

Audit Caution

HCC Buddy guidance

Using general medication codes when anticonvulsant specificity exists

Coding congenital anomalies separately without connecting to drug exposure

Confusing with sedative effects from other medications

Missing documentation of specific anticonvulsant class

Common Mistakes

HCC Buddy guidance

P04.18 — Newborn affected by other maternal medication

Q00.0 — Anencephaly (neural tube defect without drug cause documented)

P04.17 — Newborn affected by maternal use of sedative-hypnotics

P96.1 — Neonatal withdrawal symptoms from maternal drug use

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 P04.13 an HCC code?

Yes. P04.13 (Newborn affected by maternal use of anticonvulsants) maps to HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.424. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: P04.13 is billable and maps to V28 HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: P04.13
Description: Newborn affected by maternal use of anticonvulsants
HCC (V28): HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications
RAF reference coefficient: 0.424
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 137, Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

0.424

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work P04.13 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for P04.13

For P04.13, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

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What This Code Means

P04.13 is the ICD-10-CM diagnosis code for newborn affected by maternal use of anticonvulsants. The newborn was exposed to seizure-preventing medications taken by the mother during pregnancy. P04.13 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).

Under the CMS-HCC V28 risk adjustment model, P04.13 maps to Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications (HCC 137) with a source-labeled community, non-dual, aged reference coefficient of 0.424. No V24 mapping is shown for P04.13; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document which anticonvulsant(s) the mother used (e.g., phenytoin, valproic acid, phenobarbital). For P04.13, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for P04.13 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document which anticonvulsant(s) the mother used (e.g., phenytoin, valproic acid, phenobarbital)
•Monitor newborn for potential withdrawal symptoms or fetal anticonvulsant syndrome

Clinical Significance

Maternal anticonvulsant use during pregnancy can cause specific teratogenic effects including neural tube defects, cardiac malformations, and characteristic facial features in newborns. These infants require systematic evaluation for anticonvulsant embryopathy and long-term developmental monitoring.