Z38.4Twin liveborn infant, born outside hospital

Z38.4 is the ICD-10-CM diagnosis code for twin liveborn infant, born outside hospital. It belongs to category Z38 (liveborn infants according to place of birth and type of delivery), block Z30-Z39 (persons encountering health services in circumstances related to reproduction) and chapter 21 (factors influencing health status and contact with health services). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within Z38 (liveborn infants according to place of birth and type of delivery), Z38.4 is specifically for twin liveborn infant, born outside hospital. Related codes cover single liveborn infant, born in hospital (Z38.0), single liveborn infant, born outside hospital (Z38.1), single liveborn infant, unspecified as to place of birth (Z38.2), twin liveborn infant, born in hospital (Z38.3), twin liveborn infant, unspecified as to place of birth (Z38.5), other multiple liveborn infant, born in hospital (Z38.6), other multiple liveborn infant, born outside hospital (Z38.7) and other multiple liveborn infant, unspecified as to place of birth (Z38.8).

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 795 (Normal Newborn, relative weight 0.2022), 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.

The Medicare Code Editor expects this diagnosis only for newborns (age 0); reporting it for an older patient triggers an age-conflict edit.

It is exempt from present-on-admission (POA) reporting, so no POA indicator is required.

It has been part of ICD-10-CM since the code set took effect on October 1, 2015 and hasn't changed since.

Before ICD-10, this condition was coded in ICD-9-CM as V31.1 (twin birth, mate liveborn, born before admission to hospital), V31.2 (twin birth, mate liveborn, born outside hospital and not hospitalized), V32.1 (twin birth, mate stillborn, born before admission to hospital) and 3 more.