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I97.42 ICD-10-CM Code: Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other procedure

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1 · 2 Excludes2

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 919 — COMPLICATIONS OF TREATMENT WITH MCC (MDC 21)
  • MS-DRG 920 — COMPLICATIONS OF TREATMENT WITH CC (MDC 21)
  • MS-DRG 921 — COMPLICATIONS OF TREATMENT WITHOUT CC/MCC (MDC 21)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I97.42 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on I97.42 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

  • intraoperative hemorrhage and hematoma of a circulatory system organ or structure due to accidental puncture and laceration during a procedure (I97.5-) Compare I97.42 vs I97.5 →

Source: inherited from I97.4

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for I97.42

MedCoder structured workflow — derived from this code’s own official record

Before you code I97.42

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I97.42. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in I97.42’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewI97.5

Consider I97.42. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting I97.42(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I97.42: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI97.5

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of I97.42(2 notes)

    Coding workflow: The conditions named in this note are not included in I97.42. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareG97.3, T81.1

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition I97.42 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewI97.5

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other procedure is a billable ICD-10-CM diagnosis code (I97.42).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name I97.42 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 20 Excludes2 notes: T80 — Complications following infusion, transfusion and therapeutic injection (via I97.-), T80 — Complications following infusion, transfusion and therapeutic injection (via I97.4.-), T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88) (via I97.-), T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88) (via I97.4.-), T81 — Complications of procedures, not elsewhere classified (via I97.-), T81 — Complications of procedures, not elsewhere classified (via I97.4.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via I97.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via I97.4.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via I97.4.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via I97.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via I97.4.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via I97.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via I97.4.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via I97.-), T86 — Complications of transplanted organs and tissue (via I97.-), T86 — Complications of transplanted organs and tissue (via I97.4.-), T87 — Complications peculiar to reattachment and amputation (via I97.-), T87 — Complications peculiar to reattachment and amputation (via I97.4.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via I97.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via I97.4.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 84 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 919 (MDC 21), DRG 920 (MDC 21), DRG 921 (MDC 21).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR038 — Postprocedural or postoperative circulatory system complication (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

H95.813 — Postprocedural stenosis of external ear canal, bilateral, H95.819 — Postprocedural stenosis of unspecified external ear canal, H95.88 — Other intraoperative complications and disorders of the ear and mastoid process, not elsewhere classified, H95.89 — Other postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified, I85.01 — Esophageal varices with bleeding, I85.11 — Secondary esophageal varices with bleeding, I97.3 — Postprocedural hypertension, I97.410 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac catheterization, I97.411 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac bypass, I97.418 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other circulatory system procedure, I97.610 — Postprocedural hemorrhage of a circulatory system organ or structure following a cardiac catheterization, I97.611 — Postprocedural hemorrhage of a circulatory system organ or structure following cardiac bypass, I97.618 — Postprocedural hemorrhage of a circulatory system organ or structure following other circulatory system procedure, I97.620 — Postprocedural hemorrhage of a circulatory system organ or structure following other procedure, I97.621 — Postprocedural hematoma of a circulatory system organ or structure following other procedure, I97.622 — Postprocedural seroma of a circulatory system organ or structure following other procedure, I97.630 — Postprocedural hematoma of a circulatory system organ or structure following a cardiac catheterization, I97.631 — Postprocedural hematoma of a circulatory system organ or structure following cardiac bypass, I97.638 — Postprocedural hematoma of a circulatory system organ or structure following other circulatory system procedure, I97.640 — Postprocedural seroma of a circulatory system organ or structure following a cardiac catheterization, +63 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Postprocedural or postoperative circulatory system complication).

I97.121 — Postprocedural cardiac arrest following other surgery, I97.130 — Postprocedural heart failure following cardiac surgery, I97.131 — Postprocedural heart failure following other surgery, I97.190 — Other postprocedural cardiac functional disturbances following cardiac surgery, I97.191 — Other postprocedural cardiac functional disturbances following other surgery, I97.2 — Postmastectomy lymphedema syndrome, I97.3 — Postprocedural hypertension, I97.410 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac catheterization, I97.411 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac bypass, I97.418 — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other circulatory system procedure, I97.51 — Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure, I97.52 — Accidental puncture and laceration of a circulatory system organ or structure during other procedure, I97.610 — Postprocedural hemorrhage of a circulatory system organ or structure following a cardiac catheterization, I97.611 — Postprocedural hemorrhage of a circulatory system organ or structure following cardiac bypass, I97.618 — Postprocedural hemorrhage of a circulatory system organ or structure following other circulatory system procedure, I97.62 — Postprocedural hemorrhage, hematoma and seroma of a circulatory system organ or structure following other procedure, I97.620 — Postprocedural hemorrhage of a circulatory system organ or structure following other procedure, I97.621 — Postprocedural hematoma of a circulatory system organ or structure following other procedure, I97.622 — Postprocedural seroma of a circulatory system organ or structure following other procedure, I97.630 — Postprocedural hematoma of a circulatory system organ or structure following a cardiac catheterization, +25 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of I97.42 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I97.42 with these 4 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes (20)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs[MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 32,029 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Complication (s) (from) (of), intraoperative (intraprocedural), hemorrhage (hematoma) (of), circulatory system organ or structure, during other procedure[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other procedure

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I97.42 in its code family, with their registry titles.

View all codes in the I97 family