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ICD-10 Guide
ICD-10 CodesO03.5

O03.5

Billable

Genital tract and pelvic infection following complete or unspecified spontaneous abortion

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

Code Description

ICD-10 O03.5 is a billable code used to indicate a diagnosis of genital tract and pelvic infection following complete or unspecified spontaneous abortion.

Key Diagnostic Point:

O03.5 refers to infections of the genital tract and pelvis that occur after a complete or unspecified spontaneous abortion. Spontaneous abortion, commonly known as miscarriage, is the loss of a pregnancy before the 20th week. It can occur at various stages, with early miscarriages often linked to chromosomal abnormalities, while later losses may involve factors such as cervical incompetence or uterine anomalies. Following a spontaneous abortion, the risk of infection can increase due to retained products of conception or disruption of the normal vaginal flora. Symptoms may include fever, abdominal pain, and abnormal vaginal discharge. Prompt diagnosis and treatment are crucial to prevent complications such as sepsis. Emotional support is also vital for patients experiencing miscarriage, as it can be a traumatic event. Healthcare providers should ensure that patients receive both medical and psychological support during this challenging time.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between complete and incomplete spontaneous abortion
  • Identifying the presence of infection versus normal post-abortion recovery
  • Understanding the implications of retained products of conception
  • Documenting emotional support and counseling provided to the patient

Audit Risk Factors

  • Inadequate documentation of infection symptoms
  • Failure to specify the type of spontaneous abortion
  • Lack of follow-up care documentation
  • Insufficient emotional support notes

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed notes on the patient's obstetric history, current symptoms, and treatment plan are essential.

Common Clinical Scenarios

Patients presenting with fever and abdominal pain following a spontaneous abortion.

Billing Considerations

Ensure that emotional support and counseling are documented, as they are critical components of care.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors and any interventions performed.

Common Clinical Scenarios

Management of patients with recurrent miscarriages or those with known uterine anomalies.

Billing Considerations

Consider the implications of maternal health on future pregnancies and the need for specialized care.

Coding Guidelines

Inclusion Criteria

Use O03.5 When
  • Follow the official ICD
  • CM guidelines for coding obstetric conditions, ensuring that all relevant clinical information is documented
  • Specific criteria for diagnosing infections post
  • abortion must be met

Exclusion Criteria

Do NOT use O03.5 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 when managing a patient with complications following a spontaneous abortion.

Documentation Requirements

Document all aspects of care, including counseling and follow-up.

Specialty Considerations

Obstetricians should ensure comprehensive care is documented.

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.

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.

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.

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 should be documented to support the use of O03.5?

Documentation should include the type of spontaneous abortion, symptoms of infection, treatment provided, and any emotional support offered to the patient.