Is O42.1 a billable ICD-10-CM code?

No. O42.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does O42.1 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).

O42.1

O42.1 — Premature rupture of membranes, onset of labor more than 24 hours following rupture

Non-billable headerICD-10-CM

O42.1 is a non-billable header ICD-10-CM code for premature rupture of membranes, onset of labor more than 24 hours following rupture. It cannot be billed on its own: choose one of the more specific child codes below.

Risk adjustment

O42.1 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 O42.1

3 child codes. Green means billable.

Related codes at this level

Codes that share O42. If O42.1 is not quite right, the correct code is usually one of these.

Questions about O42.1

Is O42.1 a billable ICD-10-CM code?: No. O42.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does O42.1 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).