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ICD-10 Guide
ICD-10 CodesChapter 15: Pregnancy, childbirth and the puerperiumO04

O04

Non-billable

Complications following (induced) termination of pregnancy

Chapter 15:Pregnancy, childbirth and the puerperium

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 O04 is a used to indicate a diagnosis of complications following (induced) termination of pregnancy.

Key Diagnostic Point:

The ICD-10 Level 1 Category code O04 encompasses complications that arise following an induced termination of pregnancy. This includes a range of conditions such as hemorrhage, infection, and other adverse effects that may occur post-procedure. Clinically, these complications can significantly affect the patient's recovery and overall health, necessitating careful monitoring and management. The importance of this category lies in its ability to capture the various complications that may arise, allowing healthcare providers to address these issues promptly and effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in complications
  • Need for detailed clinical documentation
  • Potential for overlapping diagnoses

Audit Risk Factors

  • Inadequate documentation of complications
  • Misclassification of complications
  • Failure to report all relevant conditions

Specialty Focus

Medical Specialties

Obstetrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Gynecology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical and administrative impact of the O04 code category is significant, as it allows for the identification and management of complications that may arise after an induced termination of pregnancy. This can influence quality measures and population health initiatives, as tracking these complications helps healthcare providers improve care delivery and patient outcomes. Additionally, understanding the trends associated with these complications can inform healthcare policies and practices, ultimately enhancing the overall quality of care provided to patients.

ICD-9 vs ICD-10

The clinical and administrative impact of the O04 code category is significant, as it allows for the identification and management of complications that may arise after an induced termination of pregnancy. This can influence quality measures and population health initiatives, as tracking these complications helps healthcare providers improve care delivery and patient outcomes. Additionally, understanding the trends associated with these complications can inform healthcare policies and practices, ultimately enhancing the overall quality of care provided to patients.

Reimbursement & Billing Impact

reimbursement. It is also important to consider the payer's specific guidelines regarding coverage for complications, as these can vary. Proper coding not only aids in reimbursement but also plays a crucial role in tracking patient outcomes and ensuring quality care.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for O04

Coding & Billing References

  • •
    Official ICD-10 Guidelines for O04

Frequently Asked Questions

What conditions are included in O04?

O04 includes conditions such as hemorrhage, infection, and other complications that may arise after an induced termination of pregnancy. It is essential to document the specific nature of the complication for accurate coding.

When should I use O04 codes?

O04 codes should be used when a patient presents with complications following an induced termination of pregnancy. This includes any adverse effects that occur during the recovery period.

What documentation is required for O04?

Documentation should include details of the termination procedure, any complications encountered, the treatment provided, and the patient's response to treatment. This ensures accurate coding and appropriate reimbursement.