P04.0 vs P96.1
P04.0 and P96.1 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter. The distinction is perinatal vs later onset.
The official note, declared on P96.1
reactions and intoxications from maternal opiates and tranquilizers administered during labor and delivery (P04.0)
P04.0
Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P00-P04
Use when the record says
- Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery
Indexed under
- Absorption › chemical › through placenta › obstetric anesthetic or analgesic drug
- Absorption › drug NEC › through placenta › obstetric anesthetic or analgesic drug
- Newborn › affected by › maternal › analgesia (infant) (liveborn) (singleton)
- Newborn › affected by › maternal › anesthesia (infant) (liveborn) (singleton)
- Newborn › affected by › maternal › tranquilizers administered for procedures during pregnancy or labor and delivery (infant) (liveborn) (singleton)
P96.1
Neonatal withdrawal symptoms from maternal use of drugs of addiction
Billable
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P90-P96
Use when the record says
- Drug withdrawal syndrome in infant of dependent mother
- Neonatal abstinence syndrome
Indexed under
- Abstinence symptoms, syndrome › neonatal
- Newborn › abstinence syndrome (infant) (liveborn) (singleton)
- Syndrome › abstinence, neonatal
- Syndrome › drug withdrawal, infant of dependent mother
- Syndrome › neonatal abstinence
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027