P04.2

Billable

Newborn affected by maternal use of tobacco

HCC Category Mapping

V28HCC 137 — Drug Use Disorder/Substance Use Disorder, Moderate/Severe

0.358

What This Code Means

A newborn affected by the mother's tobacco use during pregnancy, which can result in low birth weight, prematurity, or other developmental complications.

Coding Tips

•Document the extent of maternal tobacco exposure and specific effects observed in the newborn
•This code applies to passive or active maternal smoking during pregnancy with documented newborn effects

Clinical Significance

Maternal tobacco use during pregnancy significantly increases risks for low birth weight, preterm delivery, sudden infant death syndrome, and respiratory complications. These newborns require enhanced monitoring for growth, respiratory function, and developmental milestones.

Documentation Requirements

✓Documentation of maternal tobacco use during pregnancy
✓Amount and duration of tobacco exposure
✓Birth weight and gestational age assessment
✓Respiratory status evaluation
✓Growth parameters and percentiles
✓Evidence of nicotine withdrawal in newborn
✓Risk counseling provided to family

Excludes 2 — Not included here, may code separately

newborn exposure to environmental tobacco smoke (P96.81)

Commonly Confused Codes

P07.18 — Other low birth weight newborn (low birth weight without tobacco cause)P04.6 — Newborn affected by maternal exposure to environmental chemicals P22.9 — Respiratory distress of newborn, unspecified P96.89 — Other specified conditions originating in the perinatal period

Code Hierarchy

└P04Newborn affected by noxious substances transmitted via placenta or breast milk └P04.2Newborn affected by maternal use of tobacco

└P04.2Newborn affected by maternal use of tobacco