ICD-10 O04
Non-Billable HeaderComplications following (induced) termination of pregnancy
About ICD-10-CM O04
ICD-10-CM code O04 represents Complications following (induced) termination of pregnancy. This is a non-billable header code in the Pregnancy, Childbirth, and Puerperium chapter (block O04). The 2026 edition of ICD-10-CM O04 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for O04
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Type 2 Excludes
Not included here, the excluded code is not part of O04, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- encounter for elective termination of pregnancy (Z33.2)
- failed attempted termination of pregnancy (O07.-)
Includes
- complications following (induced) termination of pregnancy
Medicare LCD Coverage for O04
Local Coverage Determinations (LCDs) from CMS MACs that list O04 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O04.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but O04 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with O04
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To O04
Other codes in section O00-O08 (Pregnancy with abortive outcome).
ICD-10 O04, Billing FAQ
Is ICD-10 code O04 billable? +
No, O04 is a non-billable header code. Use a more specific child code from block O04 when submitting claims.
What codes are Type 2 Excludes for O04? +
Type 2 Excludes (may be coded together when both conditions exist): encounter for elective termination of pregnancy (Z33.2); failed attempted termination of pregnancy (O07.-)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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