ICD-10 O04.5
Billable / Specific CCGenital tract and pelvic infection following (induced) termination of pregnancy
About ICD-10-CM O04.5
ICD-10-CM code O04.5 represents Genital tract and pelvic infection following (induced) termination of pregnancy. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O04). The 2026 edition of ICD-10-CM O04.5 became effective on October 1, 2025.
Coding Tips for O04.5
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O04.5 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under O04.5. Per CMS ICD-10-CM Tabular 2026.
- Endometritis following (induced) termination of pregnancy
- Oophoritis following (induced) termination of pregnancy
- Parametritis following (induced) termination of pregnancy
- Pelvic peritonitis following (induced) termination of pregnancy
- Salpingitis following (induced) termination of pregnancy
- Salpingo-oophoritis following (induced) termination of pregnancy
Type 1 Excludes
Pure excludes, these codes can never be coded together with O04.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- sepsis following (induced) termination of pregnancy (O04.87)
- urinary tract infection following (induced) termination of pregnancy (O04.88)
Inpatient DRG Impact, CC
codes Genital tract and pelvic infection following (induced) termination of pregnancy. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for O04.5
Local Coverage Determinations (LCDs) from CMS MACs that list O04.5 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 O04.5.
1 Cigna
CPT Codes Commonly Billed with O04.5
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.
Convert O04.5 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| O04.5 | 63502 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O04.5
Other codes in section O00-O08 (Pregnancy with abortive outcome).
ICD-10 O04.5, Billing FAQ
Is ICD-10 code O04.5 billable? +
Yes, O04.5 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to O04.5? +
ICD-10 O04.5 includes: Endometritis following (induced) termination of pregnancy; Oophoritis following (induced) termination of pregnancy; Parametritis following (induced) termination of pregnancy, and 3 more clinical synonyms.
What codes are Type 1 Excludes for O04.5? +
Type 1 Excludes (never code together with O04.5): sepsis following (induced) termination of pregnancy (O04.87); urinary tract infection following (induced) termination of pregnancy (O04.88)
Is O04.5 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does O04.5 map to? +
Per CMS GEMs, O04.5 maps to ICD-9 codes: 63502. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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