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ICD-10-CM O74.4: Toxic reaction to local anesthesia during labor and delivery

O74.4 is the billable ICD-10-CM code for toxic reaction to local anesthesia during labor and delivery, in category O74 (Complications of anesthesia during labor and delivery) of the Complications of labor and delivery section. As a principal diagnosis it groups to MS-DRG 998 Principal Diagnosis Invalid as Discharge Diagnosis (MDC 14 MDC 14: Pregnancy, Childbirth and the Puerperium). 1 LCD billing and coding article lists it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
O74.4
billable FY2027 ICD-10-CM code
Category
O74 Complications of anesthesia during labor and delivery
Chapter
15: Pregnancy, childbirth and the puerperium (O00-O9A)
CC/MCC (MS-DRG v44)
Neither
CMS-HCC V28
Not mapped
POA reporting
Required

Tabular list notes for O74.4

The tabular list has no notes on O74.4 itself; the notes below apply from its parent headings.

Inherited from O74 (Complications of anesthesia during labor and delivery)

Includes
  • maternal complications arising from the administration of a general, regional or local anesthetic, analgesic or other sedation during labor and delivery
Use additional code
  • code, if applicable, to identify specific complication

MS-DRG grouping when O74.4 is the principal diagnosis

MS-DRG v44 groups for O74.4 as principal diagnosis
MDCMS-DRGs
14 MDC 14: Pregnancy, Childbirth and the Puerperium998

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for O74.4 shows the full grouping logic.

CC/MCC status and inpatient edits

O74.4 is neither a CC nor an MCC under MS-DRG v44, so as a secondary diagnosis it does not raise the MS-DRG severity level. Check O74.4 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.
  • Medicare Code Editor: age conflict: maternity diagnosis (age 9 to 64).

CMS-HCC V28 risk adjustment

O74.4 does not map to a payment HCC in the PY2027 CMS-HCC V28 model, so on its own it does not change a Medicare Advantage risk score.

LCD billing and coding articles that list O74.4

1 current Medicare billing and coding article lists O74.4 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM O74.4 mean?

O74.4 means toxic reaction to local anesthesia during labor and delivery. It is one of 10 billable codes under O74, complications of anesthesia during labor and delivery.

Which MS-DRG does O74.4 group to?

As the principal diagnosis, O74.4 groups to MS-DRG 998 Principal Diagnosis Invalid as Discharge Diagnosis (MDC 14 MDC 14: Pregnancy, Childbirth and the Puerperium) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.