Is O03.5 a billable ICD-10-CM code?

Yes. O03.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does O03.5 sit in the tabular list?

Pregnancy, childbirth and the puerperium (O00-O9A), in the block Pregnancy with abortive outcome (O00-O08).

What cannot be coded together with O03.5?

O03.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

O03.5

O03.5 — Genital tract and pelvic infection following complete or unspecified spontaneous abortion

Billable / specific codeICD-10-CM

O03.5 is a billable, specific ICD-10-CM code for genital tract and pelvic infection following complete or unspecified spontaneous abortion. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

sepsis following complete or unspecified spontaneous abortion (O03.87)
urinary tract infection following complete or unspecified spontaneous abortion (O03.88)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Endometritis following complete or unspecified spontaneous abortion
Oophoritis following complete or unspecified spontaneous abortion
Parametritis following complete or unspecified spontaneous abortion
Pelvic peritonitis following complete or unspecified spontaneous abortion
Salpingitis following complete or unspecified spontaneous abortion
Salpingo-oophoritis following complete or unspecified spontaneous abortion

Risk adjustment

O03.5 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

How O03.5 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to O03.5.

Abortion›complicated›endometritis
Abortion›complicated›genital tract and pelvic infection
Abortion›complicated›oophoritis
Abortion›complicated›parametritis
Abortion›complicated›pelvic peritonitis
Abortion›complicated›salpingitis or salpingo-oophoritis
Abortion›complicated›infection›genital tract or pelvic

Related codes at this level

Codes that share O03. If O03.5 is not quite right, the correct code is usually one of these.

Questions about O03.5

Is O03.5 a billable ICD-10-CM code?: Yes. O03.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does O03.5 sit in the tabular list?: Pregnancy, childbirth and the puerperium (O00-O9A), in the block Pregnancy with abortive outcome (O00-O08).
What cannot be coded together with O03.5?: O03.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.