ICD-10 O90.3
Billable / Specific MCCPeripartum cardiomyopathy
About ICD-10-CM O90.3
ICD-10-CM code O90.3 represents Peripartum cardiomyopathy. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O90). The 2026 edition of ICD-10-CM O90.3 became effective on October 1, 2025.
Coding Tips for O90.3
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O90.3 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under O90.3. Per CMS ICD-10-CM Tabular 2026.
- Conditions in I42.- arising during pregnancy and the puerperium
Type 1 Excludes
Pure excludes, these codes can never be coded together with O90.3. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- pre-existing heart disease complicating pregnancy and the puerperium (O99.4-)
Inpatient DRG Impact, MCC
codes Peripartum cardiomyopathy. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for O90.3
Local Coverage Determinations (LCDs) from CMS MACs that list O90.3 as a covered diagnosis.
Showing top 10 of 211 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O90.3.
3 Cigna
5 Medicare
CPT Codes Commonly Billed with O90.3
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 O90.3 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 |
|---|---|---|
| O90.3 | 67452 | 10000 |
| O90.3 | 67454 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O90.3
Other codes in section O85-O92 (Complications predominantly related to the puerperium).
ICD-10 O90.3, Billing FAQ
Is ICD-10 code O90.3 billable? +
Yes, O90.3 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 O90.3? +
ICD-10 O90.3 includes: Conditions in I42.- arising during pregnancy and the puerperium.
What codes are Type 1 Excludes for O90.3? +
Type 1 Excludes (never code together with O90.3): pre-existing heart disease complicating pregnancy and the puerperium (O99.4-)
Is O90.3 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 O90.3 map to? +
Per CMS GEMs, O90.3 maps to ICD-9 codes: 67452, 67454. 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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