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ICD-10 Guide
ICD-10 CodesO34.5

O34.5

Billable

Maternal care for other abnormalities of gravid uterus

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

Code Description

ICD-10 O34.5 is a billable code used to indicate a diagnosis of maternal care for other abnormalities of gravid uterus.

Key Diagnostic Point:

O34.5 refers to maternal care for various abnormalities of the gravid uterus that may complicate pregnancy. This includes conditions such as uterine fibroids, abnormal pelvic organ positioning, and previous cesarean sections that may lead to uterine scarring. These abnormalities can affect the growth and development of the fetus, increase the risk of complications during labor, and necessitate specialized monitoring and management strategies. For instance, women with a history of cesarean delivery may face risks such as uterine rupture or placenta accreta in subsequent pregnancies. Additionally, abnormalities of the pelvic organs can lead to issues such as obstructed labor or abnormal fetal positioning. Proper documentation of these conditions is crucial for ensuring appropriate care and coding accuracy, as they can significantly impact the management of the pregnancy and delivery process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying conditions (e.g., fibroids, scarring)
  • Need for detailed patient history and previous obstetric outcomes
  • Variability in clinical management based on specific abnormalities
  • Potential for multiple co-existing conditions requiring careful documentation

Audit Risk Factors

  • Inadequate documentation of the specific abnormality
  • Failure to capture the impact of the abnormality on pregnancy management
  • Misclassification of the abnormality leading to incorrect coding
  • Lack of follow-up documentation for ongoing maternal care

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed history of previous pregnancies, surgical history, and current pregnancy complications.

Common Clinical Scenarios

Management of a patient with a history of cesarean delivery presenting with uterine scarring and fibroids.

Billing Considerations

Ensure accurate documentation of the type and extent of uterine abnormalities and their implications for delivery.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessment of maternal and fetal health, including imaging studies and consultations.

Common Clinical Scenarios

Monitoring a high-risk pregnancy with multiple uterine abnormalities and previous surgical history.

Billing Considerations

Focus on the potential for complications and the need for specialized care plans.

Coding Guidelines

Inclusion Criteria

Use O34.5 When
  • According to ICD
  • 10 coding guidelines, O34
  • 5 should be used when there is clear documentation of the abnormality affecting the gravid uterus
  • Coders must ensure that the condition is actively being managed and that it impacts the course of the pregnancy

Exclusion Criteria

Do NOT use O34.5 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

59400CPT Code

Obstetric care including antepartum care, delivery, and postpartum care

Clinical Scenario

Used for comprehensive care of a patient with uterine abnormalities throughout pregnancy.

Documentation Requirements

Complete documentation of all visits, assessments, and management plans.

Specialty Considerations

Obstetricians should ensure that all aspects of care are documented to support the coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including abnormalities of the gravid uterus. This specificity helps in better tracking of maternal health outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including abnormalities of the gravid uterus. This specificity helps in better tracking of maternal health outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including abnormalities of the gravid uterus. This specificity helps in better tracking of maternal health outcomes and resource allocation.

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 types of abnormalities are covered under O34.5?

O34.5 covers a range of abnormalities of the gravid uterus, including uterine fibroids, scarring from previous surgeries, and other pelvic organ abnormalities that may complicate pregnancy.