Excludes1 pair
O02.1 vs O36.4-
O02.1 and O36.4 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on O02.1
fetal death (intrauterine) (late) (O36.4)
O02.1
Missed abortion
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O00-O08
Use when the record says
- Early fetal death, before completion of 20 weeks of gestation, with retention of dead fetus
Indexed under
- Abortion › missed
- Missed › abortion
- Dead › fetus, retained › early pregnancy
- Retention › products of conception › early pregnancy (dead fetus)
- Delivery › complicated › by › intrauterine fetal death, early
O36.4
Maternal care for intrauterine death
Not billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O30-O48
Use when the record says
- Maternal care for intrauterine fetal death NOS
- Maternal care for intrauterine fetal death after completion of 20 weeks of gestation
- Maternal care for late fetal death
- Maternal care for missed delivery
Indexed under
- Dead › fetus, retained (mother)
- Delivery › missed (at or near term)
- Missed › delivery
- Pregnancy › complicated by › death of fetus (near term)
- Pregnancy › complicated by › intrauterine fetal death (near term)
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027