Is O42 a billable ICD-10-CM code?

No. O42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does O42 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).

O42

O42 — Premature rupture of membranes

Non-billable headerICD-10-CM

O42 is a non-billable header ICD-10-CM code for premature rupture of membranes. It cannot be billed on its own: choose one of the more specific child codes below.

Risk adjustment

O42 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.

Code to one of these instead O42

3 child codes. Green means billable.

O42.0Premature rupture of membranes, onset of labor within 24 hours of rupture
O42.1Premature rupture of membranes, onset of labor more than 24 hours following rupture
O42.9Premature rupture of membranes, unspecified as to length of time between rupture and onset of labor

Questions about O42

Is O42 a billable ICD-10-CM code?: No. O42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does O42 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).