O45 vs O99.111

O45 (Premature separation of placenta [abruptio placentae]) compared with O99.111 (Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester), from the official CMS tabular data.

Summary

These codes should not be reported together because O99.111’s tabular entry lists O45 under Excludes1.

Official rule

What is different?

The conditions named and billing status.O45 is “Premature separation of placenta [abruptio placentae]”; O99.111 is “Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester”. O45 is a non-billable header; O99.111 is billable.

Registry fact

Can these codes be reported together?

No.O99.111’s entry carries an Excludes1 note covering O45: “hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.O99.111’s tabular entry: “hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)”. The note covers O45.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. O99.111 carries 1 Excludes2 note covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.O45 is a non-billable header, but O99.111 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Conflict

Excludes1 conflict

O99.111

Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester

↔

O45

Premature separation of placenta [abruptio placentae]

What we found

No — do not report together.O99.111 carries an Excludes1 note covering O45: “hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2 Check these on a claim

Why it matters

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

Section I.A.12.a — Excludes1 · applies to: Excludes1
A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.
ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

	O45Premature separation of placenta [abruptio placentae]	O99.111Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester
Billing status	Non-billable header Report instead: O45.001, O45.002, O45.003, O45.009, O45.011	Billable
Classification	O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A)	O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A)
Definition	Premature separation of placenta [abruptio placentae] is a non-billable ICD-10-CM category code (O45).	Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester is a billable ICD-10-CM diagnosis code (O99.111).
Includes	—	conditions which complicate the pregnant state, are aggravated by the pregnancy or are a main reason for obstetric care
Excludes1	—	hemorrhage with coagulation defects (O45.-, O46.0-, O67.0, O72.3)
Excludes2	—	when the reason for maternal care is that the condition is known or suspected to have affected the fetus (O35-O36)
Use additional code	—	code to identify specific condition

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources