Abortion Complications and Related ICD-10 Codes

Many women present to the emergency department following abortion. The risk of an emergency department (ED) visit is especially pronounced for drug-induced abortions, with the Food and Drug Administration label for the abortion drug mifepristone acknowledging that 2.9% to 4.6% of women who use mifepristone may end up in the ED. Research shows that ED visits following the use of abortion drugs are more likely to be complex and severe than visits following surgical abortion or live birth or among women who are not pregnant.

Clinical Risks and Emergency Department Trends

Historically, many women who experienced a complication from abortion drugs did not return to the abortion center, instead relying on emergency departments and other providers for care. Now that abortion drugs are available via the mail, many women may live hundreds of miles from the abortionist who sent them the drugs, making it very likely that any complications will be treated by other providers, including an ED. Furthermore, even though abortion drugs will not resolve an ectopic pregnancy and risks increase with advancing gestation, many women using these drugs are not screened for ectopic pregnancy or gestational age, meaning that they may present to the ED with these complications.

Coding Challenges and Accuracy

Despite these risks, research shows that a high majority (84%) of abortion-drug-related ED visits are miscoded, and these miscoded visits are more likely to be severe and complex. Not only does this miscoding potentially undermine the care women receive, it also results in an undercount of complications associated with abortion drugs, which may explain the low ED rates in published research based on ED data alone. For these reasons, CLI has compiled this list of ICD-10 codes associated with abortion drug complications as a resource for emergency physicians and other ED clinicians as well as recommendations for future coding updates.

ICD-10 Codes for Complications Following Termination of Pregnancy

Listed below are the currently available ICD-10 codes for abortion complications. There are thirteen general categories of complications following successful termination of pregnancy (ending the embryonic/fetal life):

• O04.5: Genital tract and pelvic infection following (induced) termination of pregnancy
• O04.6: Delayed or excessive hemorrhage following (induced) termination of pregnancy
• O04.7: Embolism following (induced) termination of pregnancy
• O04.80: (Induced) termination of pregnancy with unspecified complications
• O04.81: Shock following (induced) termination of pregnancy
• O04.82: Renal failure following (induced) termination of pregnancy
• O04.83: Metabolic disorder following (induced) termination of pregnancy
• O04.84: Damage to pelvic organs following (induced) termination of pregnancy
• O04.85: Other venous complications following (induced) termination of pregnancy
• O04.86: Cardiac arrest following (induced) termination of pregnancy
• O04.87: Sepsis following (induced) termination of pregnancy
• O04.88: Urinary tract infection following (induced) termination of pregnancy
• O04.89: (Induced) termination of pregnancy with other complications

ICD-10 Codes for Failed Attempted Termination

The following codes are used less commonly because they indicate the abortion procedure has not been successful in ending the life of the embryo or fetus. Although they are sometimes misused to indicate the abortion procedure has been unsuccessful in extruding all the pregnancy tissue, this is an inaccurate use of the code because abortion is defined as an action having the “intent to end the unborn life.” Successful death of the embryo/fetus but retained pregnancy tissue should be coded with a different complication code, but unfortunately this specific code does not exist. There are fourteen general categories of complications following failed attempted termination of pregnancy:

• O07.0: Genital tract and pelvic infection following failed attempted termination of pregnancy
• O07.1: Delayed or excessive hemorrhage following failed attempted termination of pregnancy
• O07.2: Embolism following failed attempted termination of pregnancy
• O07.30: Failed attempted termination of pregnancy with unspecified complications
• O07.31: Shock following failed attempted termination of pregnancy
• O07.32: Renal failure following failed attempted termination of pregnancy
• O07.33: Metabolic disorder following failed attempted termination of pregnancy
• O07.34: Damage to pelvic organs following failed attempted termination of pregnancy
• O07.35: Other venous complications following failed attempted termination of pregnancy
• O07.36: Cardiac arrest following failed attempted termination of pregnancy
• O07.37: Sepsis following failed attempted termination of pregnancy
• O07.38: Urinary tract infection following failed attempted termination of pregnancy
• O07.39: Failed attempted termination of pregnancy with other complications
• O07.4: Failed attempted termination of pregnancy without complication