Is ICD-10-CM code O92 billable?

No, O92 (Other disorders of breast and disorders of lactation associated with pregnancy and the puerperium) 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 O92 belong to?

O92 belongs to Chapter 15 of the ICD-10-CM tabular list: O00–O9A (Pregnancy, Childbirth and the Puerperium).

O92Not billable, use a more specific code below

Other disorders of breast and disorders of lactation associated with pregnancy and the puerperium

In Complications predominantly related to the puerperium (O85-O92), chapter 15: Pregnancy, Childbirth and the Puerperium

20 billable codes under O92: none are a CC or MCC; none map to an HCC.

Instructional notes

Also applies, from Complications predominantly related to the puerperium (O85-O92)

These notes sit on O85-O92 and apply to every code under it, including O92.

Excludes2: not included here, code separately if applicable

mental and behavioral disorders associated with the puerperium (F53.-)
obstetrical tetanus (A34)
puerperal osteomalacia (M83.0)

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 O92

O92 can't be used on a claim. Pick a billable code below; grey headings group them.

O92 MS-DRGs

As the principal diagnosis, the billable codes under O92 group to these 8 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 769 Postpartum and Post Abortion Diagnoses with O.R. Procedures (12 of 20 codes)
DRG 776 Postpartum and Post Abortion Diagnoses without O.R. Procedures (12 of 20 codes)
DRG 817 Other Antepartum Diagnoses with O.R. Procedures with MCC (8 of 20 codes)
DRG 818 Other Antepartum Diagnoses with O.R. Procedures with CC (8 of 20 codes)
DRG 819 Other Antepartum Diagnoses with O.R. Procedures without CC/MCC (8 of 20 codes)
DRG 831 Other Antepartum Diagnoses without O.R. Procedures with MCC (8 of 20 codes)
DRG 832 Other Antepartum Diagnoses without O.R. Procedures with CC (8 of 20 codes)
DRG 833 Other Antepartum Diagnoses without O.R. Procedures without CC/MCC (8 of 20 codes)

Other codes that refer to O92

Notes on these codes point to O92.

N60-N65 Excludes1: disorders of breast associated with childbirth (O91-O92)
Z39.1 Excludes1: disorders of lactation (O92.-)

About the condition

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

Breast Diseases

Breast diseases include various conditions and changes in your breast. Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges of fluids that are not breast milk.

Breastfeeding

Breastfeeding offers many benefits to your baby. Breast milk contains the right balance of nutrients to help your infant grow into a strong and healthy toddler. Some of the nutrients in breast milk also help protect your infant against some common childhood illnesses and infections. It may also help your health. Certain types of cancer may occur less often in mothers who have breastfed their babies.

Code history

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