2025 ICD-10-CM code O03.5
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pregnancy - Pregnancy with abortive outcome Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Genital tract and pelvic infection following complete or unspecified spontaneous abortion.
The medical necessity for coding O03.5 is established by the presence of clinical findings consistent with a genital tract or pelvic infection following a spontaneous abortion. This necessitates appropriate diagnosis, treatment, and monitoring by a healthcare professional to prevent potential complications such as sepsis or infertility.
The clinical responsibility for coding O03.5 rests with the physician or qualified healthcare professional managing the patient's post-abortion care.This includes diagnosing the infection, ordering appropriate laboratory tests (e.g., cultures), prescribing antibiotics, and monitoring the patient's response to treatment.Documentation must clearly support the diagnosis and treatment plan.
- Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
- O00-O08: Pregnancy with abortive outcome
In simple words: This code is for infections in the female reproductive organs that happen after a miscarriage.The infection could be in the womb lining, ovaries, or other parts of the pelvis.It does not include infections of the bladder or bloodstream.
This code describes genital tract and pelvic infections that occur as a complication following a complete or unspecified spontaneous abortion (miscarriage).The infection may involve the endometrium (endometritis), ovaries (oophoritis), parametrium (parametritis), pelvic peritoneum (pelvic peritonitis), fallopian tubes (salpingitis), or a combination of these (salpingo-oophoritis).It excludes sepsis and urinary tract infections that occur after a spontaneous abortion.
Example 1: A 30-year-old woman experiences a spontaneous abortion at 8 weeks gestation. Following the abortion, she develops fever, lower abdominal pain, and vaginal discharge.A pelvic exam reveals cervical motion tenderness.Cultures reveal the presence of *E. coli*.A diagnosis of endometritis is made, and the patient is treated with intravenous antibiotics., A 25-year-old woman presents with lower abdominal pain and fever 3 days after a miscarriage at 10 weeks.She reports vaginal bleeding and foul-smelling discharge. Pelvic ultrasound reveals evidence of a tubo-ovarian abscess. A diagnosis of salpingo-oophoritis is made, and the patient is admitted to the hospital for intravenous antibiotics and surgical drainage of the abscess., A 40-year-old woman had a miscarriage at 12 weeks.She is seen in the office a week later complaining of pelvic pain.Exam reveals tenderness to palpation.Labs reveal elevated white blood cell count.A diagnosis of pelvic inflammatory disease is made.The patient is started on oral antibiotics.
Detailed history of the spontaneous abortion, including gestational age at the time of the abortion.Results of pelvic examination (including cervical motion tenderness).Laboratory results (e.g., complete blood count, blood cultures, cervical and vaginal cultures).Imaging studies (e.g., ultrasound).Documentation of antibiotic therapy and the patient's response to treatment.
** This code should not be used if the infection is unrelated to the pregnancy or miscarriage.If the infection is severe or life-threatening, consider additional coding to reflect the severity of the illness.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Infectious Disease
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Emergency Room - Hospital