P00-P04
Medium Complexity
Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery
Primary Specialty: Neonatology
Last Updated: 2025-09-10
ICD-10 Codes (69)
68 billable0 category headers
P01P01.0Billable
P01.1Billable
P01.2Billable
P01.3Billable
P01.4Billable
P01.5Billable
P01.6Billable
P01.7Billable
P01.8Billable
P01.9Billable
P02Billable
P02.0Billable
P02.1Billable
P02.2Billable
P02.20Billable
P02.29Billable
P02.3Billable
P02.4Billable
P02.5Billable
P02.6Billable
P02.60Billable
P02.69Billable
P02.7Billable
P02.70Billable
P02.78Billable
P02.8Billable
P02.9Billable
P03Billable
P03.0Billable
P03.1Billable
P03.2Billable
P03.3Billable
P03.4Billable
P03.5Billable
P03.6Billable
P03.8Billable
P03.81Billable
P03.810Billable
P03.811Billable
P03.819Billable
P03.82Billable
P03.89Billable
P03.9Billable
P04Billable
P04.0Billable
P04.1Billable
P04.11Billable
P04.12Billable
P04.13Billable
P04.14Billable
P04.15Billable
P04.16Billable
P04.17Billable
P04.18Billable
P04.19Billable
P04.2Billable
P04.3Billable
P04.4Billable
P04.40Billable
P04.41Billable
P04.42Billable
P04.49Billable
P04.5Billable
P04.6Billable
P04.8Billable
P04.81Billable
P04.89Billable
P04.9Billable
Updates & Changes
FY 2026 Updates
Current Year
New Codes (1)
P04.49
Newborn affected by maternal use of other drugs of addiction
Revised Codes (1)
P04.17
Newborn affected by maternal use of cocaine - updated neonatal abstinence syndrome correlation
Deleted Codes
No codes deleted in this range for FY 2026
Historical Changes
- •FY 2025: Routine maintenance updates with minor terminology clarifications
- •FY 2024: Enhanced specificity requirements for certain code ranges
- •FY 2023: Updated documentation guidelines for improved clarity
Upcoming Changes
- •Proposed updates pending review by Coordination and Maintenance Committee
- •Under consideration: Enhanced digital health integration codes
Implementation Guidance
- •Review all FY 2026 updates for P00-P04 codes before implementation
- •Always verify the most current codes in the ICD-10-CM manual
- •Ensure clinical documentation supports the selected diagnosis codes
- +3 more guidance items...
Range Overview
high priority
The ICD-10 code range P00-P04 pertains to newborns affected by maternal factors and complications of pregnancy, labor, and delivery. These codes are used to document conditions in newborns that are directly linked to maternal health issues or complications during pregnancy and childbirth. They cover a broad spectrum of conditions, from maternal infectious diseases affecting the newborn, to birth injuries resulting from complicated labor and delivery.
Key Usage Points:
- •These codes are used when a newborn's condition is directly linked to maternal factors.
- •The codes can be used for both live births and stillbirths.
- •The codes cover both maternal diseases and complications during pregnancy, labor, and delivery.
- •The codes are not used for congenital anomalies or diseases inherent in the newborn.
- •The codes should be used in conjunction with other codes to provide a complete picture of the newborn's health.
Coding Guidelines
When to Use:
- ✓When a newborn is affected by maternal hypertensive disorders.
- ✓When a newborn is affected by maternal infectious and parasitic diseases.
- ✓When a newborn is affected by complications of placenta, cord and membranes.
- ✓When a newborn is affected by other complications of labor and delivery.
- ✓When a newborn is affected by maternal nutritional disorders.
When NOT to Use:
- ✗When the newborn's condition is not directly linked to maternal factors.
- ✗When the newborn's condition is a congenital anomaly.
- ✗When the newborn's condition is a disease inherent in the newborn.
- ✗When the newborn's condition is due to postnatal factors.
- ✗When the newborn's condition is due to complications during the neonatal period.
Code Exclusions
Always verify exclusions by consulting the ICD-10-CM Official Guidelines for Coding and Reporting.
Documentation Requirements
Documentation for P00-P04 codes should clearly link the newborn's condition to maternal factors or complications of pregnancy, labor, and delivery. It should include a detailed description of the newborn's condition, the maternal factor or complication, and the impact on the newborn's health.
Clinical Information:
- •Detailed description of the newborn's condition.
- •Specific maternal factor or complication.
- •Impact of the maternal factor or complication on the newborn's health.
- •Outcome of the newborn's condition.
- •Any treatment provided to the newborn.
Supporting Evidence:
- •Laboratory test results.
- •Imaging results.
- •Clinical notes from the treating physician.
- •Notes from the delivery.
Good Documentation Example:
Newborn affected by maternal gestational diabetes, resulting in macrosomia. Mother's blood glucose levels were poorly controlled during pregnancy. Newborn required treatment for hypoglycemia.
Poor Documentation Example:
Newborn with macrosomia.
Common Documentation Errors:
- âš Failure to link the newborn's condition to a maternal factor or complication.
- âš Failure to provide a detailed description of the newborn's condition.
- âš Failure to document the impact of the maternal factor or complication on the newborn's health.
- âš Failure to document any treatment provided to the newborn.
Range Statistics
5
Total Codes
68
Billable
Complexity:
Medium
Primary Use:Clinical Documentation
Chapter:16
Coding Complexity
Medium
Complexity Rating
The complexity of coding with the P00-P04 range lies in the need to establish a clear link between the newborn's condition and a maternal factor or complication. The broad range of conditions covered by these codes also adds to the complexity. However, with careful review of the clinical documentation and a solid understanding of the ICD-10-CM Official Guidelines for Coding and Reporting, coders can accurately use these codes.
Key Factors:
- â–¸Determining the direct link between the newborn's condition and a maternal factor or complication.
- â–¸Navigating the broad range of conditions covered by these codes.
- â–¸Excluding conditions not directly linked to maternal factors or complications.
- â–¸Using these codes in conjunction with other codes to provide a complete picture of the newborn's health.
Specialty Focus
The P00-P04 range is particularly relevant to specialties dealing with newborn care, such as neonatology and pediatrics, as well as obstetrics and gynecology.
Primary Specialties:
Neonatology
40%
Obstetrics and Gynecology
35%
Pediatrics
25%
Clinical Scenarios:
- • Newborn affected by maternal infectious disease, such as HIV.
- • Newborn affected by maternal nutritional disorder, such as vitamin D deficiency.
- • Newborn affected by complications of placenta, cord and membranes, such as placental insufficiency.
- • Newborn affected by maternal hypertensive disorders, such as preeclampsia.
- • Newborn affected by other complications of labor and delivery, such as birth trauma.
Resources & References
Resources for coding with the P00-P04 range include the ICD-10-CM Official Guidelines for Coding and Reporting, clinical reference materials, and educational resources on neonatal coding.
Official Guidelines:
- ICD-10-CM Official Guidelines for Coding and Reporting
- American Health Information Management Association (AHIMA) Coding Guidelines
- Centers for Medicare & Medicaid Services (CMS) ICD-10 Provider Resources
Clinical References:
- American Academy of Pediatrics (AAP) Neonatal Resuscitation Program
- World Health Organization (WHO) International Classification of Diseases (ICD)
Educational Materials:
- AHIMA ICD-10-CM Coding Workbook for OB/GYN
- AAP Coding for Pediatrics
Frequently Asked Questions
Can P00-P04 codes be used for stillbirths?
Yes, P00-P04 codes can be used for both live births and stillbirths, as long as the condition is directly linked to a maternal factor or complication.