O9A.23 ICD-10-CM Code: Injury, poisoning and certain other consequences of external causes complicating the puerperium

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for O9A.23 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on O9A.23 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for O9A.23

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

Before you code O9A.23

1. 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 →

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.

Official instructions as workflow

• Excludes2 — not part of O9A.23(1 note)

  Coding workflow: The conditions named in this note are not included in O9A.23. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareO9A.3, O9A.4, O9A.5

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

• Use Additional Code — after identifying O9A.23(1 note)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with O9A.23 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

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.

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.

• Puerperal, puerperium (complicated by, complications), trauma, non-obstetric

Official Coding Guidelines

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

Don’t confuse O9A.23 with…

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

The codes most likely to be picked instead of O9A.23 — 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.

• O9A.3— 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 physical, sexual and psychological abuse complicating pregnancy, childbirth and the puerperium adds O9A.3; it is not part of this code and both may be reported when both are documented.

  Full comparison: O9A.23 vs O9A.3 →

• O9A.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 physical, sexual and psychological abuse complicating pregnancy, childbirth and the puerperium adds O9A.4; it is not part of this code and both may be reported when both are documented.

  Full comparison: O9A.23 vs O9A.4 →

• O9A.5— 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 physical, sexual and psychological abuse complicating pregnancy, childbirth and the puerperium adds O9A.5; it is not part of this code and both may be reported when both are documented.

  Full comparison: O9A.23 vs O9A.5 →

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.

Verify Before Coding

• Age-restricted: the Medicare Code Editor lists this as a maternity (age 9-64) diagnosis; other ages are presumed incorrect.

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 O9A.23 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 1 Excludes2 note: O99.8 — Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium (via O9A.2.-).

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.

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 2 MS-DRGs: DRG 769 (MDC 14), DRG 776 (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):PRG027 — Complications specified during the puerperium (default); INJ027 — Other unspecified injury.

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 category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Complications specified during the puerperium, Other unspecified injury).

O99.825 — Streptococcus B carrier state complicating the puerperium, O99.835 — Other infection carrier state complicating the puerperium, O99.845 — Bariatric surgery status complicating the puerperium, O99.893 — Other specified diseases and conditions complicating puerperium, O9A.13 — Malignant neoplasm complicating the puerperium, O9A.211 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, first trimester, O9A.212 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, second trimester, O9A.213 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, third trimester, O9A.219 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, unspecified trimester, O9A.22 — Injury, poisoning and certain other consequences of external causes complicating childbirth, O9A.33 — Physical abuse complicating the puerperium, O9A.43 — Sexual abuse complicating the puerperium, O9A.53 — Psychological abuse complicating the puerperium, R45.88 — Nonsuicidal self-harm, S05.90XA — Unspecified injury of unspecified eye and orbit, initial encounter, S05.91XA — Unspecified injury of right eye and orbit, initial encounter, S05.92XA — Unspecified injury of left eye and orbit, initial encounter, S09.301A — Unspecified injury of right middle and inner ear, initial encounter, S09.302A — Unspecified injury of left middle and inner ear, initial encounter, S09.309A — Unspecified injury of unspecified middle and inner ear, initial encounter, +170 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Puerperal, puerperium”; these codes share that main term but sit in a different category of the Tabular List.

O98.73 — Human immunodeficiency virus [HIV] disease complicating the puerperium (infection, maternal, human immunodeficiency virus), O98.83 — Other maternal infectious and parasitic diseases complicating the puerperium (infection, maternal, specified NEC), O98.93 — Unspecified maternal infectious and parasitic disease complicating the puerperium (infection, maternal), O99.03 — Anemia complicating the puerperium (disease, Valsuani's), O99.13 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating the puerperium (coagulopathy), O99.215 — Obesity complicating the puerperium (obesity), O99.285 — Endocrine, nutritional and metabolic diseases complicating the puerperium (endocrine, nutritional or metabolic disease NEC), O99.315 — Alcohol use complicating the puerperium (alcohol use), O99.325 — Drug use complicating the puerperium (drug use), O99.345 — Other mental disorders complicating the puerperium (mental disorder NEC), O99.355 — Diseases of the nervous system complicating the puerperium (hemiplegia, cerebral), O99.43 — Diseases of the circulatory system complicating the puerperium (stroke), O99.53 — Diseases of the respiratory system complicating the puerperium (respiratory disease NEC), O99.63 — Diseases of the digestive system complicating the puerperium (digestive system disorder), O99.73 — Diseases of the skin and subcutaneous tissue complicating the puerperium (skin disorder NEC), O99.815 — Abnormal glucose complicating the puerperium (abnormal glucose), O99.825 — Streptococcus B carrier state complicating the puerperium (infection, maternal, streptococcus group Bcarrier state), O99.835 — Other infection carrier state complicating the puerperium (infection, maternal, carrier state NEC), O99.845 — Bariatric surgery status complicating the puerperium (gastric bypass status), O99.893 — Other specified diseases and conditions complicating puerperium (specified condition NEC), +75 more

Contextual Map

Every relationship of O9A.23 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 O9A.23 with this related code in Claim Check

Hierarchy

• O00-O9A — Chapter 15: Pregnancy, Childbirth and the Puerperium (O00-O9A) (O00-O9A)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O94-O9A — Other obstetric conditions, not elsewhere classified[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes2 notes

• O99.8 — Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium[Excludes2](via O9A.2.-): “traumatic injuries in pregnancy (O9A.2-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• PRG027 — Complications specified during the puerperium[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• INJ027 — Other unspecified injury[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 769 — POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES[MS-DRG]: “POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES (MDC 14)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 776 — POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES[MS-DRG]: “POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES (MDC 14)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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 · FY2026

Index entries

• Puerperal, puerperium (complicated by, complications), trauma, non-obstetric[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

• O9A — Maternal malignant neoplasms, traumatic injuries and abuse classifiable elsewhere but complicating pregnancy, childbirth and the puerperium[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.1 — Malignant neoplasm complicating pregnancy, childbirth and the puerperium[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.11 — Malignant neoplasm complicating pregnancy[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.111 — Malignant neoplasm complicating pregnancy, first trimester[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.112 — Malignant neoplasm complicating pregnancy, second trimester[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.113 — Malignant neoplasm complicating pregnancy, third trimester[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.119 — Malignant neoplasm complicating pregnancy, unspecified trimester[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O9A.12 — Malignant neoplasm complicating childbirth[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

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

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section 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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to O9A.23 in its code family, with their registry titles.

• O9A.211 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, first trimester
• O9A.212 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, second trimester
• O9A.213 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, third trimester
• O9A.219 — Injury, poisoning and certain other consequences of external causes complicating pregnancy, unspecified trimester
• O9A.22 — Injury, poisoning and certain other consequences of external causes complicating childbirth
• O9A.3 — Physical abuse complicating pregnancy, childbirth and the puerperium
• O9A.31 — Physical abuse complicating pregnancy
• O9A.311 — Physical abuse complicating pregnancy, first trimester
• O9A.312 — Physical abuse complicating pregnancy, second trimester
• O9A.313 — Physical abuse complicating pregnancy, third trimester

View all codes in the O9A family