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P04.8 ICD-10-CM Code: Newborn affected by other maternal noxious substances

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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)

P04.8

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Newborn affected by other maternal noxious substances

Newborn affected by other maternal noxious substances

CMS-HCC V28

0

0

RAF 0

CMS-HCC V24

0

0

RAF 0

ACA/HHS

0

0

RAF 0

ESRD/PACE

0

0

RAF 0

RXHCC

0

0

RAF 0

Code Trumping

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Code Book Path

Official
P04Newborn affected by noxious substances transmitted via placenta or breast milk
P04.8Newborn affected by other maternal noxious substances

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for P04.8 in this effective period.

Excludes 2

Official
  • congenital malformations (Q00-Q99)
  • encounter for observation of newborn for suspected diseases and conditions ruled out (Z05.-)
  • neonatal jaundice from excessive hemolysis due to drugs or toxins transmitted from mother (P58.4)
  • newborn in contact with and (suspected) exposures hazardous to health not transmitted via placenta or breast milk (Z77.-)

Related Child Codes

Official
P04.81Newborn affected by maternal use of cannabis
P04.89Newborn affected by other maternal noxious substances

Includes

Official
  • nonteratogenic effects of substances transmitted via placenta

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for P04.8 in this effective period.

Code First

Official
  • any current condition in newborn, if applicable

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for P04.8 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for P04.8 in this effective period.

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

What This Code Means

P04.8 is the ICD-10-CM diagnosis code for newborn affected by other maternal noxious substances. P04.8 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).

Header codes like P04.8 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at P04.8's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for P04.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Child Codes

Code Hierarchy

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