Questionable Obstetric Admission ICD-10-PCS
The questionable obstetric admission edit is a coverage check in Medicare’s claim-validation software, the Medicare Code Editor (MCE). It covers the 8 ICD-10-PCS procedure codes listed below. A cesarean section or vaginal delivery procedure reported without a corresponding outcome of delivery diagnosis makes the MCE flag the admission as questionable, so the Z37 outcome code belongs on every delivery claim.
Diagnosis Condition
These delivery procedures are considered a questionable admission unless one of the following outcome of delivery diagnoses is reported as a secondary diagnosis on the claim.
Procedure Codes in This Edit 8 codes · 1 category
Pregnancy8 codes
- 10D00Z0 Extraction of Products of Conception, High, Open Approach
- 10D00Z1 Extraction of Products of Conception, Low, Open Approach
- 10D00Z2 Extraction of Products of Conception, Extraperitoneal, Open Approach
- 10D07Z3 Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening
- 10D07Z4 Extraction of Products of Conception, Mid Forceps, Via Natural or Artificial Opening
- 10D07Z5 Extraction of Products of Conception, High Forceps, Via Natural or Artificial Opening
- 10D07Z7 Extraction of Products of Conception, Internal Version, Via Natural or Artificial Opening
- 10E0XZZ Delivery of Products of Conception, External Approach
Questions About This Code Edit
What is the questionable obstetric admission Medicare code edit?
The following procedure codes describing a cesarean section or vaginal delivery are considered to be a questionable admission except when reported with a corresponding secondary diagnosis code describing the outcome of delivery. The Medicare Code Editor flags any inpatient claim that triggers the check.
How many codes are on the questionable obstetric admission list?
The FY 2027 list contains 8 codes, imported from the CMS Definitions of Medicare Code Edits v44.0.
When does the questionable obstetric admission edit apply?
These delivery procedures are considered a questionable admission unless one of the following outcome of delivery diagnoses is reported as a secondary diagnosis on the claim. The condition list contains 19 ICD-10-CM diagnosis codes.
Does this edit make the codes invalid?
No. Every code on this list is a valid code. The edit is about Medicare payment rules, not about whether the code exists or can be documented.
Other ICD-10-PCS Medicare Code Edits
Source: CMS Definitions of Medicare Code Edits v44.0, effective October 1, 2026 through September 30, 2027. Code lists are imported directly from the official manual. See also the ICD-10-CM diagnosis edits and the MS-DRG list.
