Is O36.4 a billable ICD-10-CM code?

No. O36.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does O36.4 sit in the tabular list?

Pregnancy, childbirth and the puerperium (O00-O9A), in the block Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48).

What cannot be coded together with O36.4?

O36.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

O36.4

O36.4 — Maternal care for intrauterine death

Non-billable headerICD-10-CM

O36.4 is a non-billable header ICD-10-CM code for maternal care for intrauterine death. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

One of the following 7th characters is to be assigned to each code under category O36. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be assigned when assigning a code from category O36 that has a 7th character of 1 through 9.

0: not applicable or unspecified
1: fetus 1
2: fetus 2
3: fetus 3
4: fetus 4
5: fetus 5
9: other fetus

Excludes1 — never code together

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

missed abortion (O02.1)
stillbirth (P95)

Inclusion terms

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

Maternal care for intrauterine fetal death NOS
Maternal care for intrauterine fetal death after completion of 20 weeks of gestation
Maternal care for late fetal death
Maternal care for missed delivery

Other codes that can never be billed with O36.4

These codes carry an Excludes1 note pointing at O36.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading O36.4 alone.

O02.1Missed abortion
P95Stillbirth
Z33.2Encounter for elective termination of pregnancy

Risk adjustment

O36.4 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 O36.4 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 O36.4.

Dead›fetus, retained(mother)
Delivery›missed(at or near term)
Missed›delivery
Pregnancy›complicated by›death of fetus(near term)
Pregnancy›complicated by›intrauterine fetal death(near term)
Retention›dead›fetus(at or near term) (mother)
Retention›fetus›dead
Pregnancy›complicated by›fetal›death(near term)
Pregnancy›complicated by›fetal›intrauterine death
Pregnancy›complicated by›missed›delivery

Code to one of these instead O36.4

7 child codes. Green means billable.

Related codes at this level

Codes that share O36. If O36.4 is not quite right, the correct code is usually one of these.

Questions about O36.4

Is O36.4 a billable ICD-10-CM code?: No. O36.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does O36.4 sit in the tabular list?: Pregnancy, childbirth and the puerperium (O00-O9A), in the block Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48).
What cannot be coded together with O36.4?: O36.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.