Is O04.5 a billable ICD-10-CM code?

Yes. O04.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does O04.5 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 O04.5?

O04.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

O04.5

O04.5 — Genital tract and pelvic infection following (induced) termination of pregnancy

Billable / specific codeICD-10-CM

O04.5 is a billable, specific ICD-10-CM code for genital tract and pelvic infection following (induced) termination of pregnancy. 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 (induced) termination of pregnancy (O04.87)
urinary tract infection following (induced) termination of pregnancy (O04.88)

Inclusion terms

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

Endometritis following (induced) termination of pregnancy
Oophoritis following (induced) termination of pregnancy
Parametritis following (induced) termination of pregnancy
Pelvic peritonitis following (induced) termination of pregnancy
Salpingitis following (induced) termination of pregnancy
Salpingo-oophoritis following (induced) termination of pregnancy

Risk adjustment

O04.5 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 O04.5 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 O04.5.

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

Related codes at this level

Codes that share O04. If O04.5 is not quite right, the correct code is usually one of these.

Questions about O04.5

Is O04.5 a billable ICD-10-CM code?: Yes. O04.5 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does O04.5 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 O04.5?: O04.5 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.