Is O98.5 a billable ICD-10-CM code?

No. O98.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does O98.5 sit in the tabular list?

Pregnancy, childbirth and the puerperium (O00-O9A), in the block Other obstetric conditions, not elsewhere classified (O94-O9A).

What cannot be coded together with O98.5?

O98.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.

O98.5

O98.5 — Other viral diseases complicating pregnancy, childbirth and the puerperium

Non-billable headerICD-10-CM

O98.5 is a non-billable header ICD-10-CM code for other viral diseases complicating pregnancy, childbirth and the puerperium. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

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

human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium (O98.7-)

Inclusion terms

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

Conditions in A80-B09, B25-B34, R87.81-, R87.82-

Excludes2 inherited from the categories above O98.5

Also inherited, and the opposite of Excludes1: these conditions are not part of O98.5, but a patient can have both, so you may code both.

Written on O98 — Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium

herpes gestationis (O26.4-)
infectious carrier state (O99.82-, O99.83-)
obstetrical tetanus (A34)
puerperal infection (O86.-)
puerperal sepsis (O85)
when the reason for maternal care is that the disease is known or suspected to have affected the fetus (O35-O36)

Risk adjustment

O98.5 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.

Code history

O98.5 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead O98.5

3 child codes. Green means billable.

Related codes at this level

Codes that share O98. If O98.5 is not quite right, the correct code is usually one of these.

Questions about O98.5

Is O98.5 a billable ICD-10-CM code?: No. O98.5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does O98.5 sit in the tabular list?: Pregnancy, childbirth and the puerperium (O00-O9A), in the block Other obstetric conditions, not elsewhere classified (O94-O9A).
What cannot be coded together with O98.5?: O98.5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter.