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O98.513 ICD-10-CM Code: Other viral diseases complicating pregnancy, third trimester

Compare with another code for O98.513Check this code on a claim

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

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1 · 6 Excludes2 · 1 use-additional code

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codefrom O98Report with this code when documented
  • Use additional code (Chapter 1), to identify specific infectious or parasitic disease
Excludes1from O98.5Not reported with this code unless documented as unrelated
  • human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium (O98.7-)
Excludes2from O98Not included here; may be reported together
  • herpes gestationis (O26.4-)
  • infectious carrier state (O99.82-, O99.83-)
  • obstetrical tetanus (A34)
  • puerperal infection (O86.-)

+2 more in Instructions

Includesfrom O98What O98 covers
  • the listed conditions when complicating the pregnant state, when aggravated by the pregnancy, or as a reason for obstetric care

Where it sits Source: CMS/NCHS

Under:Chapter 15: Pregnancy, Childbirth and the PuerperiumO94-O9A Other obstetric conditions, not elsewhere classifiedO98 Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperiumO98.5 Other viral diseases complicating pregnancy, childbirth and the puerperiumO98.51 Other viral diseases complicating pregnancy

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

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 v44, Appendix B.

  • MS-DRG 817 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC (MDC 14)
  • MS-DRG 818 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC (MDC 14)
  • MS-DRG 819 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC (MDC 14)
  • MS-DRG 831 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC (MDC 14)
  • MS-DRG 832 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC (MDC 14)
  • MS-DRG 833 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC (MDC 14)

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 O98.513 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on O98.513 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • the listed conditions when complicating the pregnant state, when aggravated by the pregnancy, or as a reason for obstetric care

Source: inherited from O98

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).

Source: inherited from O98.5

Excludes2 — Not Included Here

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

Source: inherited from O98

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code (Chapter 1), to identify specific infectious or parasitic disease

Source: inherited from O98

Coder workflow for O98.513

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

Before you code O98.513

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on O98.513; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Confirm the condition is documented as complicating the pregnancy, childbirth, or the puerperium, and check the trimester where the code carries one and the fetus character where the category requires it. Chapter 15 codes belong on the maternal record only and take sequencing priority over codes from other chapters. It is the provider’s responsibility to state that a condition is not affecting the pregnancy; the trimester is assigned from the documentation (Guidelines I.C.15.a, I.C.15.a.1, I.C.15.a.3).

    Guide: How to choose an ICD-10-CM code →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with O98.513. 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 O98.513’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.

    ReviewO98.7

Consider O98.513. Then work the Use Additional Code note, and 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).
Trimester
Assigned from the documented trimester at the encounter, or the trimester in which the condition developed for inpatient stays (Guidelines I.C.15.a.3).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Any detail beyond this code’s title
What the record states that a more specific code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting O98.513(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O98.513: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareO98.7

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

  • Excludes2 — not part of O98.513(6 notes)

    Coding workflow: The conditions named in this note are not included in O98.513. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareO26.4, O99.82, O99.83, A34, O86, O85

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

  • Use Additional Code — after identifying O98.513(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with O98.513 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

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

Documentation: Both the condition O98.513 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).

ReviewO98.7

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with O98.513?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

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.

Don’t confuse O98.513 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of O98.513 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • O98.7— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of human immunodeficiency virus [HIV] disease complicating pregnancy, childbirth and the puerperium moves the case to O98.7; the two are not reported together unless documented as unrelated.

    Full comparison: O98.513 vs O98.7 →

  • O98.519— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Other viral diseases complicating pregnancy, unspecified trimester” takes O98.519; specificity in the record moves it back here.

    Full comparison: O98.513 vs O98.519 →

  • O26.4— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of herpes gestationis adds O26.4; it is not part of this code and both may be reported when both are documented.

    Full comparison: O98.513 vs O26.4 →

  • O99.82— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of infectious carrier state adds O99.82; it is not part of this code and both may be reported when both are documented.

    Full comparison: O98.513 vs O99.82 →

  • O99.83— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of infectious carrier state adds O99.83; it is not part of this code and both may be reported when both are documented.

    Full comparison: O98.513 vs O99.83 →

  • A34— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of obstetrical tetanus adds A34; it is not part of this code and both may be reported when both are documented.

    Full comparison: O98.513 vs A34 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Other viral diseases complicating pregnancy, third trimester is a billable ICD-10-CM diagnosis code (O98.513).

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

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

s. COVID-19 infection in pregnancy, childbirth, and the puerperium During pregnancy, childbirth or the puerperium, when COVID-19 is the reason for admission/encounter, code O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should be sequenced as the principal/first-listed diagnosis, and code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) should be assigned as additional diagnoses. Codes from Chapter 15 always take sequencing priority.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

If the reason for admission/encounter is unrelated to COVID-19 but the patient has been diagnosed with COVID-19 during the admission/encounter, the appropriate code for the reason for admission/encounter should be sequenced as the principal/first-listed diagnosis, and codes O98.5- and U07.1, as well as the appropriate codes for associated COVID-19 manifestations, should be assigned as additional diagnoses.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 6 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as a maternity (age 9-64) diagnosis; other ages are presumed incorrect.
  • CC as a secondary diagnosis (FY2027). 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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name O98.513 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 10 Excludes2 notes: O20 — Hemorrhage in early pregnancy (via O98.-), O20-O29 — Other maternal disorders predominantly related to pregnancy (O20-O29) (via O98.-), O21 — Excessive vomiting in pregnancy (via O98.-), O22 — Venous complications and hemorrhoids in pregnancy (via O98.-), O23 — Infections of genitourinary tract in pregnancy (via O98.-), O24 — Diabetes mellitus in pregnancy, childbirth, and the puerperium (via O98.-), O25 — Malnutrition in pregnancy, childbirth and the puerperium (via O98.-), O26 — Maternal care for other conditions predominantly related to pregnancy (via O98.-), O28 — Abnormal findings on antenatal screening of mother (via O98.-), O29 — Complications of anesthesia during pregnancy (via O98.-).

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

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: 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 36 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 6 MS-DRGs: DRG 817 (MDC 14), DRG 818 (MDC 14), DRG 819 (MDC 14), DRG 831 (MDC 14), DRG 832 (MDC 14), DRG 833 (MDC 14).

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

Clinical classification (AHRQ CCSR):PRG028 — Other specified complications in pregnancy (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.

O98.411 — Viral hepatitis complicating pregnancy, first trimester, O98.412 — Viral hepatitis complicating pregnancy, second trimester, O98.413 — Viral hepatitis complicating pregnancy, third trimester, O98.419 — Viral hepatitis complicating pregnancy, unspecified trimester, O98.42 — Viral hepatitis complicating childbirth, O98.43 — Viral hepatitis complicating the puerperium, O98.511 — Other viral diseases complicating pregnancy, first trimester, O98.512 — Other viral diseases complicating pregnancy, second trimester, O98.519 — Other viral diseases complicating pregnancy, unspecified trimester, O98.52 — Other viral diseases complicating childbirth, O98.53 — Other viral diseases complicating the puerperium, O98.611 — Protozoal diseases complicating pregnancy, first trimester, O98.612 — Protozoal diseases complicating pregnancy, second trimester, O98.613 — Protozoal diseases complicating pregnancy, third trimester, O98.711 — Human immunodeficiency virus [HIV] disease complicating pregnancy, first trimester, O98.712 — Human immunodeficiency virus [HIV] disease complicating pregnancy, second trimester, O98.713 — Human immunodeficiency virus [HIV] disease complicating pregnancy, third trimester, O98.719 — Human immunodeficiency virus [HIV] disease complicating pregnancy, unspecified trimester, O98.72 — Human immunodeficiency virus [HIV] disease complicating childbirth, O98.73 — Human immunodeficiency virus [HIV] disease complicating the puerperium, +15 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Other specified complications in pregnancy).

+318 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.

HIV Screening Test, HIV Viral Load

Contextual Map

Every relationship of O98.513 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 O98.513 with these 8 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes (10)

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 14 — Pregnancy, Childbirth and the Puerperium[MDC crossing]: “Pregnancy, Childbirth and the Puerperium — 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. 94 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

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

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "O98.513 — Other viral diseases complicating pregnancy, third trimester." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/o98.513-other-viral-diseases-complicating-pregnancy-third-trimester

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other viral diseases complicating pregnancy, third trimester

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 O98.513 in its code family, with their registry titles.

View all codes in the O98 family