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ICD-10 Guide
ICD-10 CodesO03.0

O03.0

Billable

Genital tract and pelvic infection following incomplete spontaneous abortion

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O03.0 is a billable code used to indicate a diagnosis of genital tract and pelvic infection following incomplete spontaneous abortion.

Key Diagnostic Point:

O03.0 refers to infections of the genital tract and pelvis that occur after an incomplete spontaneous abortion, which is defined as the loss of a pregnancy before the 20th week of gestation where some but not all of the products of conception are expelled. This condition can lead to serious complications, including sepsis, if not properly managed. The incomplete nature of the abortion can result in retained tissue, which can become infected, leading to pelvic inflammatory disease or other serious infections. Emotional support is crucial for patients experiencing spontaneous abortion, as they may face significant psychological distress. Healthcare providers should ensure that patients receive appropriate counseling and support during this challenging time. The management of this condition typically involves careful monitoring, possible surgical intervention to remove retained products, and antibiotic therapy to address any infections. Proper documentation of the patient's clinical status, the extent of the abortion, and any interventions performed is essential for accurate coding and billing.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between complete and incomplete spontaneous abortion
  • Identifying the presence of infection and its severity
  • Documenting emotional and psychological support provided
  • Understanding the implications of retained products of conception

Audit Risk Factors

  • Inadequate documentation of the abortion's completeness
  • Failure to document the presence and type of infection
  • Lack of emotional support documentation
  • Misclassification of the type of abortion

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of the patient's obstetric history, the nature of the abortion, and any treatments provided.

Common Clinical Scenarios

Patients presenting with bleeding and cramping in early pregnancy, requiring evaluation for spontaneous abortion.

Billing Considerations

Ensure emotional support and counseling are documented, as they are critical for patient care.

Maternal-Fetal Medicine

Documentation Requirements

Thorough documentation of high-risk factors, including maternal health conditions and previous pregnancy complications.

Common Clinical Scenarios

Management of patients with a history of recurrent pregnancy loss or those presenting with complications during early pregnancy.

Billing Considerations

Focus on the management of both maternal and fetal health, including the need for specialized interventions.

Coding Guidelines

Inclusion Criteria

Use O03.0 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring that all relevant clinical details are documented
  • Specific criteria for coding spontaneous abortion and associated infections must be met, including the gestational age and completeness of the abortion

Exclusion Criteria

Do NOT use O03.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58150CPT Code

Dilation and curettage (D&C)

Clinical Scenario

Used for surgical management of incomplete spontaneous abortion with infection.

Documentation Requirements

Document the indication for the procedure, including the diagnosis of incomplete abortion and infection.

Specialty Considerations

Ensure that the procedure is linked to the diagnosis of O03.0 for accurate billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the accuracy of diagnoses and treatment tracking. O03.0 provides a clear distinction between types of spontaneous abortion and their complications, enhancing clinical data quality.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the accuracy of diagnoses and treatment tracking. O03.0 provides a clear distinction between types of spontaneous abortion and their complications, enhancing clinical data quality.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the accuracy of diagnoses and treatment tracking. O03.0 provides a clear distinction between types of spontaneous abortion and their complications, enhancing clinical data quality.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between incomplete and complete spontaneous abortion?

Incomplete spontaneous abortion refers to a situation where some but not all products of conception are expelled from the uterus, potentially leading to complications such as infection. In contrast, complete spontaneous abortion means that all products of conception have been expelled, and typically does not lead to further complications.