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ICD-10-CM 2027 diagnosis code

P04.3Newborn affected by maternal use of alcohol

✓ Billable / specific

P04.3 is a valid, billable ICD-10-CM code for newborn affected by maternal use of alcohol. It can be reported on claims for dates of service from October 1, 2026 – September 30, 2027.

Code last changed in FY2017 (effective October 1, 2016). Source: official FY2027 ICD-10-CM release from CDC/NCHS and CMS. Page updated September 29, 2026. About our data

About P04.3

P04.3 is the ICD-10-CM diagnosis code for newborn affected by maternal use of alcohol. It belongs to category P04 (newborn affected by noxious substances transmitted via placenta or breast milk), block P00-P04 (newborn affected by maternal factors and by complications of pregnancy, labor, and delivery) and chapter 16 (certain conditions originating in the perinatal period). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within P04 (newborn affected by noxious substances transmitted via placenta or breast milk), P04.3 is specifically for newborn affected by maternal use of alcohol. Related codes cover maternal anesthesia and analgesia in pregnancy, labor and delivery (P04.0), other maternal medication (P04.1), maternal use of tobacco (P04.2), maternal use of drugs of addiction (P04.4), maternal use of nutritional chemical substances (P04.5), maternal exposure to environmental chemical substances (P04.6), other maternal noxious substances (P04.8) and maternal noxious substance, unspecified (P04.9).

Don't report P04.3 together with the conditions in its Excludes1 note: fetal alcohol syndrome (Q86.0).

Code first: any current condition in newborn, if applicable.

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 794 (Neonate with Other Significant Problems, relative weight 1.4935), in MDC 15 (Newborns and Other Neonates with Conditions Originating in the Perinatal Period), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015, and changed in FY2017 (title revised).

Before ICD-10, this condition was coded in ICD-9-CM as 760.71 (alcohol affecting fetus or newborn via placenta or breast milk).

Coding notes

Excludes1Not coded here — never report together with this code
  • fetal alcohol syndrome (Q86.0)

Notes that apply from higher levels

Instructions written at a parent level also apply to P04.3.

› From P04 Newborn affected by noxious substances transmitted via placenta or breast milk
Includes
  • nonteratogenic effects of substances transmitted via placenta
Excludes2
  • 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

Broader instructions also apply from P00-P04 Newborn affected by maternal factors and by complications of pregnancy, labor, and delivery and Chapter 16: Certain conditions originating in the perinatal period.

Alphabetic index entries

1 entries

Terms in the official ICD-10-CM index that lead to P04.3.

MS-DRG v44.0 grouping

All DRGs →

Inpatient MS-DRGs this diagnosis can group to, as the principal or a secondary diagnosis, depending on the rest of the claim.

MDC 15 · Newborns and Other Neonates with Conditions Originating in the Perinatal Period

ICD-9-CM equivalent

Converter →
  • 760.71Alcohol affecting fetus or newborn via placenta or breast milkapproximate

From the CMS 2018 General Equivalence Mappings (GEMs), the final GEMs release.

Code history

  1. 2016
  2. 2017
  3. 2018
  4. 2019
  5. 2020
  6. 2021
  7. 2022
  8. 2023
  9. 2024
  10. 2025
  11. 2026
  12. 2027
  • FY2016 (effective 10/1/2015): Added (first year of ICD-10-CM)
  • FY2017 (effective 10/1/2016): Title revised — was “Newborn (suspected to be) affected by maternal use of alcohol”

Common questions about P04.3

Is P04.3 billable?

Yes. P04.3 is a billable/specific ICD-10-CM code valid for FY2027 (October 1, 2026 – September 30, 2027).

Can P04.3 be used as a principal diagnosis?

Yes. The Medicare Code Editor doesn't restrict P04.3 as a principal diagnosis.

Is P04.3 a CC or MCC?

No. P04.3 is neither a CC nor an MCC under MS-DRG v44.0.

What DRG does P04.3 group to?

P04.3 is used in the MS-DRG v44.0 logic for MS-DRG 794 (Neonate with Other Significant Problems). Which one applies depends on whether it is the principal diagnosis and on the rest of the claim.

What is the ICD-9 code for P04.3?

The CMS General Equivalence Mappings map P04.3 to ICD-9-CM 760.71.