Is O99.11 a billable ICD-10-CM code?

No. O99.11 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does O99.11 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 O99.11?

O99.11 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above O99.11 (O99.1) and apply to it just the same.

O99.11

O99.11 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy

Non-billable headerICD-10-CM

O99.11 is a non-billable header ICD-10-CM code for other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above O99.11

These are not written on O99.11, but they bind it: a note on a category applies to every code beneath it. Billing O99.11 with anything listed here is a denial.

Written on O99.1 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, childbirth and the puerperium

hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)

Excludes2 inherited from the categories above O99.11

Also inherited, and the opposite of Excludes1: these conditions are not part of O99.11, but a patient can have both, so you may code both.

Written on O99 — Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium

when the reason for maternal care is that the condition is known or suspected to have affected the fetus (O35-O36)

Risk adjustment

O99.11 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

O99.11 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 O99.11

4 child codes. Green means billable.

Related codes at this level

Codes that share O99.1. If O99.11 is not quite right, the correct code is usually one of these.

Questions about O99.11

Is O99.11 a billable ICD-10-CM code?: No. O99.11 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does O99.11 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 O99.11?: O99.11 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above O99.11 (O99.1) and apply to it just the same.