Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 11.06.02i


Attachment:A

Policy #:11.06.02i

Description:Diagnosis codes ICD-10

Title:Elective Abortion


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



ICD-10 Diagnosis Codes

O07.4 Failed attempted termination of pregnancy without complication

O30.101 Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester

O30.102 Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester

O30.103 Triplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

O30.111 Triplet pregnancy with two or more monochorionic fetuses, first trimester

O30.112 Triplet pregnancy with two or more monochorionic fetuses, second trimester

O30.113 Triplet pregnancy with two or more monochorionic fetuses, third trimester

O30.121 Triplet pregnancy with two or more monoamniotic fetuses, first trimester

O30.122 Triplet pregnancy with two or more monoamniotic fetuses, second trimester

O30.123 Triplet pregnancy with two or more monoamniotic fetuses, third trimester

O30.131 Triplet pregnancy, trichorionic/triamniotic, first trimester

O30.132 Triplet pregnancy, trichorionic/triamniotic, second trimester

O30.133 Triplet pregnancy, trichorionic/triamniotic, third trimester

O30.139 Triplet pregnancy, trichorionic/triamniotic, unspecified trimester

O30.191 Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester

O30.192 Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester

O30.193 Triplet pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester

O30.201 Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, first trimester

O30.202 Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, second trimester

O30.203 Quadruplet pregnancy, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

O30.211 Quadruplet pregnancy with two or more monochorionic fetuses, first trimester

O30.212 Quadruplet pregnancy with two or more monochorionic fetuses, second trimester

O30.213 Quadruplet pregnancy with two or more monochorionic fetuses, third trimester

O30.221 Quadruplet pregnancy with two or more monoamniotic fetuses, first trimester

O30.222 Quadruplet pregnancy with two or more monoamniotic fetuses, second trimester

O30.223 Quadruplet pregnancy with two or more monoamniotic fetuses, third trimester

O30.231 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, first trimester

O30.232 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, second trimester

O30.233 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, third trimester

O30.239 Quadruplet pregnancy, quadrachorionic/quadra-amniotic, unspecified trimester

O30.831 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, first trimester

O30.832 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, second trimester

O30.833 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, third trimester

O30.839 Other specified multiple gestation, number of chorions and amnions are both equal to the number of fetuses, unspecified trimester

O30.291 Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, first trimester

O30.292 Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, second trimester

O30.293 Quadruplet pregnancy, unable to determine number of placenta and number of amniotic sacs, third trimester

O30.801 Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, first trimester

O30.802 Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, second trimester

O30.803 Other specified multiple gestation, unspecified number of placenta and unspecified number of amniotic sacs, third trimester

O30.811 Other specified multiple gestation with two or more monochorionic fetuses, first trimester

O30.812 Other specified multiple gestation with two or more monochorionic fetuses, second trimester

O30.813 Other specified multiple gestation with two or more monochorionic fetuses, third trimester

O30.821 Other specified multiple gestation with two or more monoamniotic fetuses, first trimester

O30.822 Other specified multiple gestation with two or more monoamniotic fetuses, second trimester

O30.823 Other specified multiple gestation with two or more monoamniotic fetuses, third trimester

O30.891 Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, first trimester

O30.892 Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, second trimester

O30.893 Other specified multiple gestation, unable to determine number of placenta and number of amniotic sacs, third trimester

O30.91 Multiple gestation, unspecified, first trimester

O30.92 Multiple gestation, unspecified, second trimester

O30.93 Multiple gestation, unspecified, third trimester

O31.8x10 Other complications specific to multiple gestation, first trimester, not applicable or unspecified

O31.8x11 Other complications specific to multiple gestation, first trimester, fetus 1

O31.8x12 Other complications specific to multiple gestation, first trimester, fetus 2

O31.8x13 Other complications specific to multiple gestation, first trimester, fetus 3

O31.8x14 Other complications specific to multiple gestation, first trimester, fetus 4

O31.8x15 Other complications specific to multiple gestation, first trimester, fetus 5

O31.8x19 Other complications specific to multiple gestation, first trimester, other fetus

O31.8x20 Other complications specific to multiple gestation, second trimester, not applicable or unspecified

O31.8x21 Other complications specific to multiple gestation, second trimester, fetus 1

O31.8x22 Other complications specific to multiple gestation, second trimester, fetus 2

O31.8x23 Other complications specific to multiple gestation, second trimester, fetus 3

O31.8x24 Other complications specific to multiple gestation, second trimester, fetus 4

O31.8x25 Other complications specific to multiple gestation, second trimester, fetus 5

O31.8x29 Other complications specific to multiple gestation, second trimester, other fetus

O31.8x30 Other complications specific to multiple gestation, third trimester, not applicable or unspecified

O31.8x31 Other complications specific to multiple gestation, third trimester, fetus 1

O31.8x32 Other complications specific to multiple gestation, third trimester, fetus 2

O31.8x33 Other complications specific to multiple gestation, third trimester, fetus 3

O31.8x34 Other complications specific to multiple gestation, third trimester, fetus 4

O31.8x35 Other complications specific to multiple gestation, third trimester, fetus 5

O31.8x39 Other complications specific to multiple gestation, third trimester, other fetus

O35.0XX0 Maternal care for (suspected) central nervous system malformation in fetus, not applicable or unspecified

O35.0XX1 Maternal care for (suspected) central nervous system malformation in fetus, fetus 1

O35.0XX2 Maternal care for (suspected) central nervous system malformation in fetus, fetus 2

O35.0XX3 Maternal care for (suspected) central nervous system malformation in fetus, fetus 3

O35.0XX4 Maternal care for (suspected) central nervous system malformation in fetus, fetus 4

O35.0XX5 Maternal care for (suspected) central nervous system malformation in fetus, fetus 5

O35.0XX9 Maternal care for (suspected) central nervous system malformation in fetus, other fetus

O35.1XX0 Maternal care for (suspected) chromosomal abnormality in fetus, not applicable or unspecified

O35.1XX1 Maternal care for (suspected) chromosomal abnormality in fetus, fetus 1

O35.1XX2 Maternal care for (suspected) chromosomal abnormality in fetus, fetus 2

O35.1XX3 Maternal care for (suspected) chromosomal abnormality in fetus, fetus 3

O35.1XX4 Maternal care for (suspected) chromosomal abnormality in fetus, fetus 4

O35.1XX5 Maternal care for (suspected) chromosomal abnormality in fetus, fetus 5

O35.1XX9 Maternal care for (suspected) chromosomal abnormality in fetus, other fetus

O35.2XX0 Maternal care for (suspected) hereditary disease in fetus, not applicable or unspecified

O35.2XX1 Maternal care for (suspected) hereditary disease in fetus, fetus 1

O35.2XX2 Maternal care for (suspected) hereditary disease in fetus, fetus 2

O35.2XX3 Maternal care for (suspected) hereditary disease in fetus, fetus 3

O35.2XX4 Maternal care for (suspected) hereditary disease in fetus, fetus 4

O35.2XX5 Maternal care for (suspected) hereditary disease in fetus, fetus 5

O35.2XX9 Maternal care for (suspected) hereditary disease in fetus, other fetus

O35.3XX0 Maternal care for (suspected) damage to fetus from viral disease in mother, not applicable or unspecified

O35.3XX1 Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 1

O35.3XX2 Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 2

O35.3XX3 Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 3

O35.3XX4 Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 4

O35.3XX5 Maternal care for (suspected) damage to fetus from viral disease in mother, fetus 5

O35.3XX9 Maternal care for (suspected) damage to fetus from viral disease in mother, other fetus

O35.4XX0 Maternal care for (suspected) damage to fetus from alcohol, not applicable or unspecified

O35.4XX1 Maternal care for (suspected) damage to fetus from alcohol, fetus 1

O35.4XX2 Maternal care for (suspected) damage to fetus from alcohol, fetus 2

O35.4XX3 Maternal care for (suspected) damage to fetus from alcohol, fetus 3

O35.4XX4 Maternal care for (suspected) damage to fetus from alcohol, fetus 4

O35.4XX5 Maternal care for (suspected) damage to fetus from alcohol, fetus 5

O35.4XX9 Maternal care for (suspected) damage to fetus from alcohol, other fetus

O35.5XX0 Maternal care for (suspected) damage to fetus by drugs, not applicable or unspecified

O35.5XX1 Maternal care for (suspected) damage to fetus by drugs, fetus 1

O35.5XX2 Maternal care for (suspected) damage to fetus by drugs, fetus 2

O35.5XX3 Maternal care for (suspected) damage to fetus by drugs, fetus 3

O35.5XX4 Maternal care for (suspected) damage to fetus by drugs, fetus 4

O35.5XX5 Maternal care for (suspected) damage to fetus by drugs, fetus 5

O35.5XX9 Maternal care for (suspected) damage to fetus by drugs, other fetus

O35.6XX0 Maternal care for (suspected) damage to fetus by radiation, not applicable or unspecified

O35.6XX1 Maternal care for (suspected) damage to fetus by radiation, fetus 1

O35.6XX2 Maternal care for (suspected) damage to fetus by radiation, fetus 2

O35.6XX3 Maternal care for (suspected) damage to fetus by radiation, fetus 3

O35.6XX4 Maternal care for (suspected) damage to fetus by radiation, fetus 4

O35.6XX5 Maternal care for (suspected) damage to fetus by radiation, fetus 5

O35.6XX9 Maternal care for (suspected) damage to fetus by radiation, other fetus

O35.7XX0 Maternal care for (suspected) damage to fetus by other medical procedures, not applicable or unspecified

O35.7XX1 Maternal care for (suspected) damage to fetus by other medical procedures, fetus 1

O35.7XX2 Maternal care for (suspected) damage to fetus by other medical procedures, fetus 2

O35.7XX3 Maternal care for (suspected) damage to fetus by other medical procedures, fetus 3

O35.7XX4 Maternal care for (suspected) damage to fetus by other medical procedures, fetus 4

O35.7XX5 Maternal care for (suspected) damage to fetus by other medical procedures, fetus 5

O35.7XX9 Maternal care for (suspected) damage to fetus by other medical procedures, other fetus

O35.8XX0 Maternal care for other (suspected) fetal abnormality and damage, not applicable or unspecified

O35.8XX1 Maternal care for other (suspected) fetal abnormality and damage, fetus 1

O35.8XX2 Maternal care for other (suspected) fetal abnormality and damage, fetus 2

O35.8XX3 Maternal care for other (suspected) fetal abnormality and damage, fetus 3

O35.8XX4 Maternal care for other (suspected) fetal abnormality and damage, fetus 4

O35.8XX5 Maternal care for other (suspected) fetal abnormality and damage, fetus 5

O35.8XX9 Maternal care for other (suspected) fetal abnormality and damage, other fetus

O35.9XX0 Maternal care for (suspected) fetal abnormality and damage, unspecified, not applicable or unspecified

O35.9XX1 Maternal care for (suspected) fetal abnormality and damage, unspecified, fetus 1

O35.9XX2 Maternal care for (suspected) fetal abnormality and damage, unspecified, fetus 2

O35.9XX3 Maternal care for (suspected) fetal abnormality and damage, unspecified, fetus 3

O35.9XX4 Maternal care for (suspected) fetal abnormality and damage, unspecified, fetus 4

O35.9XX5 Maternal care for (suspected) fetal abnormality and damage, unspecified, fetus 5

O35.9XX9 Maternal care for (suspected) fetal abnormality and damage, unspecified, other fetus

Z33.2 Encounter for elective termination of pregnancy

Z64.0 Problems related to unwanted pregnancy

Version Effective Date: 10/01/2018
Version Issued Date: 10/01/2018
Version Reissued Date: 04/09/2020



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