P04.0 vs P96.1
P04.0 and P96.1 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported. The distinction is perinatal vs later onset.
Newborn affected by maternal anesthesia and analgesia in pregnancy, labor and delivery
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P00-P04
- Newborn affected by reactions and intoxications from maternal opiates and tranquilizers administered for procedures during pregnancy or labor and delivery
- Absorption › chemical › through placenta › obstetric anesthetic or analgesic drug
- Absorption › drug NEC › through placenta › obstetric anesthetic or analgesic drug
- Newborn › affected by › maternal › analgesia (maternal)
- Newborn › affected by › maternal › anesthesia (maternal)
- Newborn › affected by › maternal › tranquilizers administered for procedures during pregnancy or labor and delivery
Neonatal withdrawal symptoms from maternal use of drugs of addiction
- Chapter 16
- Certain conditions originating in the perinatal period
- Section
- P90-P96
- Drug withdrawal syndrome in infant of dependent mother
- Neonatal abstinence syndrome
- Abstinence symptoms, syndrome › neonatal
- Newborn › abstinence syndrome
- 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