Excludes1 pair
O90.3 vs O99-
O90.3 and O99 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 O90.3
pre-existing heart disease complicating pregnancy and the puerperium (O99.4-)
O90.3
Peripartum cardiomyopathy
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O85-O92
Use when the record says
- Conditions in I42.- arising during pregnancy and the puerperium
Indexed under
- Cardiomyopathy › peripartum
- Cardiomyopathy › postpartum
- Peripartum › cardiomyopathy
- Puerperal, puerperium › cardiomyopathy
- Failure, failed › heart › peripartum
O99
Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium
Not billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O94-O9A
Use when the record says
- conditions which complicate the pregnant state, are aggravated by the pregnancy or are a main reason for obstetric care
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