ICD-10 O60.03
Billable / Specific MCCPreterm labor without delivery, third trimester
About ICD-10-CM O60.03
ICD-10-CM code O60.03 represents Preterm labor without delivery, third trimester. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O60). The 2026 edition of ICD-10-CM O60.03 became effective on October 1, 2025.
Coding Tips for O60.03
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O60.03 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC 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.
Inpatient DRG Impact, MCC
codes Preterm labor without delivery, third trimester. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for O60.03
Local Coverage Determinations (LCDs) from CMS MACs that list O60.03 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 O60.03.
1 Cigna
1 Aetna
CPT Codes Commonly Billed with O60.03
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 O60.03 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 |
|---|---|---|
| O60.03 | 64403 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O60.03
Other codes in section O60-O77 (Complications of labor and delivery).
ICD-10 O60.03, Billing FAQ
Is ICD-10 code O60.03 billable? +
Yes, O60.03 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is O60.03 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does O60.03 map to? +
Per CMS GEMs, O60.03 maps to ICD-9 codes: 64403. 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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