Is ICD-10-CM code O04 billable?

No, O04 (Complications following (induced) termination of pregnancy) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code O04 belong to?

O04 belongs to Chapter 15 of the ICD-10-CM tabular list: O00–O9A (Pregnancy, Childbirth and the Puerperium).

O04Not billable, use a more specific code below

Complications following (induced) termination of pregnancy

In Pregnancy with abortive outcome (O00-O08), chapter 15: Pregnancy, Childbirth and the Puerperium

13 billable codes under O04: 3 are an MCC, 9 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Includes: conditions that are coded here

complications following (induced) termination of pregnancy

Excludes2: not included here, code separately if applicable

encounter for elective termination of pregnancy (Z33.2)
failed attempted termination of pregnancy (O07.-)

Also applies, from Pregnancy with abortive outcome (O00-O08)

These notes sit on O00-O08 and apply to every code under it, including O04.

Excludes1: not coded here, use a different code

continuing pregnancy in multiple gestation after abortion of one fetus or more (O31.1-, O31.3-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Coding of obstetric cases with O00-O9A codes: sequencing priority, trimester and fetus characters, principal diagnosis selection, delivery outcome, and pregnancy-related complications.

General Rules for Obstetric Cases (page 63)
Selection of OB Principal or First-listed Diagnosis (page 64)
Pre-existing conditions versus conditions due to the pregnancy (page 65)
Pre-existing hypertension in pregnancy (page 66)
Fetal Conditions Affecting the Management of the Mother (page 66)
HIV Infection in Pregnancy, Childbirth and the Puerperium (page 66)
Diabetes mellitus in pregnancy (page 66)
Long term use of insulin and oral hypoglycemics (page 67)

Read Section I.C.15 (page 63), 11 more topics

All codes under O04

O04 can't be used on a claim. Pick a billable code below; grey headings group them.

O04 MS-DRGs

As the principal diagnosis, all 13 billable codes under O04 group to MS-DRG 770 or 779 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Abortion

An induced abortion is a procedure to end a pregnancy. It can be done two different ways: An induced abortion is different from a spontaneous abortion. That is the loss of a pregnancy before the 20th week of pregnancy. It is more commonly known as a miscarriage.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.