P04.3 Newborn affected by maternal use of alcohol

Billable ICD-10-CM code, FY2026.

Excludes1 (never code together)

• fetal alcohol syndrome (Q86.0)

Applies from P04 Newborn affected by noxious substances transmitted via placenta or breast milk

Includes

• nonteratogenic effects of substances transmitted via placenta

Excludes2 (not included here)

• 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.-)

Code first

• any current condition in newborn, if applicable

Risk adjustment (HCC)

• CMS-HCC V28: HCC 137 — Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications

MS-DRG index

Defines the logic of DRG(s) 794 in MDC 15.

Approximate ICD-9-CM (GEMs)

• 760.71 Alcohol affecting fetus or newborn via placenta or breast milk (approximate)

Code annotations containing back-references to P04.3

Back-references to P04

• Type 2 Excludes: P00 Newborn affected by maternal conditions that may be unrelated to present pregnancy ("newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)")
• Type 2 Excludes: Q86 Congenital malformation syndromes due to known exogenous causes, not elsewhere classified ("nonteratogenic effects of substances transmitted via placenta or breast milk (P04.-)")
• Type 2 Excludes: Z77 Other contact with and (suspected) exposures hazardous to health ("newborn affected by noxious substances transmitted via placenta or breast milk (P04.-)")

Diagnosis Index entries for P04.3

• Newborn (infant) (liveborn) (singleton) › affected by › maternal (complication of) (use of) › alcohol

Nearby codes

• P04.17 Newborn affected by maternal use of sedative-hypnotics
• P04.1A Newborn affected by maternal use of anxiolytics
• P04.18 Newborn affected by other maternal medication
• P04.19 Newborn affected by maternal use of unspecified medication
• P04.2 Newborn affected by maternal use of tobacco
• P04.3 Newborn affected by maternal use of alcohol (this code)
• P04.4 Newborn affected by maternal use of drugs of addiction
• P04.40 Newborn affected by maternal use of unspecified drugs of addiction
• P04.41 Newborn affected by maternal use of cocaine
• P04.42 Newborn affected by maternal use of hallucinogens
• P04.49 Newborn affected by maternal use of other drugs of addiction