ICD-10 Code N74: Female pelvic inflammatory disorders in diseases classified elsewhere

Key takeaways

ICD-10 code N74 is a single, billable ICD-10-CM code for female pelvic inflammatory disorders documented as a manifestation of an underlying disease classified elsewhere – it has no N74.0-N74.4 subcodes in the US classification.

N74 carries a generic Code first instruction: sequence the underlying disease first, then N74, whenever that disease does not already have its own dedicated combination code.

N74’s Excludes1 note rules out ten specific conditions, including gonococcal, chlamydial, syphilitic, tuberculous, herpesviral, and trichomonal pelvic inflammatory disease and cervicitis – each already has its own standalone combination code and is never paired with N74.

N74 differs from N73 (other female pelvic inflammatory diseases) in that N73 is used when no code-first-eligible underlying disease is documented, while N74 always requires that documented etiology.

Pabau’s claims management software validates insurer-submission fields and gates claim sending, while structured client records and Echo AI help clinicians document the underlying disease driving N74 at the point of care.

ICD-10 code N74 covers female pelvic inflammatory disorders that occur as a manifestation of an underlying disease. It almost never appears alone on a claim.

The tabular list requires a Code first instruction for the underlying disease. Leave N74 on a claim with no etiology code, and it raises a compliance flag right away.

The opposite mistake happens too. Coders sometimes reach for N74 when the true cause is gonorrhea, chlamydia, syphilis, tuberculosis, herpes, or trichomoniasis. Each of those already has its own dedicated code, and none of them ever pairs with N74.

This page reflects the 2026 ICD-10-CM edition, effective October 1, 2025 through September 30, 2026. CMS’s ICD-10 codes program and the CDC National Center for Health Statistics maintain it.

ICD-10 code N74 is billable, but it never stands alone

ICD-10 code N74 is a billable, specific ICD-10-CM diagnosis code, reported as a single three-character code with no further subdivisions. It is valid for use on claims submitted for reimbursement in the FY2026 coding cycle. The official full description is Female pelvic inflammatory disorders in diseases classified elsewhere.

The code belongs to Chapter 14 (Diseases of the genitourinary system, N00-N99), within the block N70-N77 (Inflammatory diseases of female pelvic organs).

The key clinical meaning: the pelvic inflammatory presentation is a manifestation of another disease, documented and coded elsewhere in the record. It isn’t a primary gynecologic infection with its own combination code. Unlike a header code, N74 is reportable as a stand-alone diagnosis code. The ICD-10-CM classification simply doesn’t split it into organism-specific subcodes the way some coders expect.

Always verify the current year’s code status against CMS’s ICD-10-CM releases, as descriptions and instructional notes update annually.

Why the underlying disease always comes before N74

N74 carries a Code first instruction, and it’s a generic one: “Code first underlying disease.” Unlike some manifestation codes, the ICD-10-CM tabular list does not attach a named list of qualifying diseases to N74. That makes documentation review, not a lookup table, the coder’s main tool here.

Under the ICD-10-CM Official Guidelines for coding and reporting, the etiology-manifestation convention requires the underlying disease to be sequenced first, followed by the manifestation. Reverse that order, or omit the etiology code entirely, and the claim is likely to be rejected or flagged on audit.

Three things the documentation must establish before N74 can be assigned:

• The underlying disease is confirmed and documented, with its own ICD-10-CM code
• The pelvic inflammatory presentation is stated as a direct manifestation of that disease, not an incidental, co-occurring finding
• That underlying disease is not one of the ten conditions on N74’s Excludes1 list (see below). Each of those already has its own combination code, and none is ever sequenced with N74

Take pelvic actinomycosis, sometimes linked to prolonged IUD use. It isn’t on N74’s Excludes1 list. When a clinician documents “pelvic inflammatory disease secondary to actinomycosis,” the sequencing runs A42- first, then N74 second. That’s the etiology-manifestation pair working the way the tabular list intends. The underlying disease keeps its own code, and N74 captures the pelvic manifestation.

Ten conditions that N74 can never be paired with

Excludes1 is a hard restriction. It means the listed condition can never be coded at the same time as N74. That’s because the condition already has its own dedicated combination code for that exact presentation. This is the opposite of a pairing instruction. It’s a list of conditions N74 must never sit alongside.

Here’s the practical rule. Each of these ten conditions is reported with its own code, alone, on its own line. None of them ever pairs with N74 plus an etiology code. If the documented cause is gonorrhea, chlamydia, syphilis, tuberculosis, herpes, or trichomoniasis, N74 does not belong on the claim at all.

Sexual health and women’s health practices managing STI-related pelvic infections should verify these exclusions against the current CMS tabular list every fiscal year. Practices relying on OB/GYN EMR software to drive claim generation need this distinction built into the diagnosis picklist, not just the coder’s memory.

Where N74 fits among the other pelvic inflammatory disease codes

Choosing the right code from the N70-N77 block depends on whether the inflammation has its own confirmed cause. It also depends on whether that cause already carries a dedicated combination code. N74 and N73 (other female pelvic inflammatory diseases) are the two most frequently confused codes in this block.

Decision rule: if no underlying disease is documented, or the cause is gonorrhea, chlamydia, syphilis, tuberculosis, herpes, or trichomoniasis, skip N74. Unspecified or non-STI-related PID goes to N73. The ten Excludes1 conditions each get their own standalone combination code, used alone. N74 is reserved for the remaining case. It needs a confirmed, documented underlying disease that isn’t one of those ten and doesn’t already have its own combination code for the pelvic manifestation.

Four chart notes that show when N74 applies, and when it doesn’t

These examples show how documentation drives code selection, including the cases where N74 shouldn’t be used at all. Each scenario starts with what the clinician wrote and ends with the correct code assignment.

Scenario 1: Confirmed gonorrhea with pelvic spread

Chart note: “Patient presents with pelvic pain and cervical motion tenderness. NAAT positive for Neisseria gonorrhoeae. Pelvic inflammatory disease secondary to gonococcal infection confirmed.”
Code assignment: A54.24 alone (gonococcal female pelvic inflammatory disease). Gonococcal PID is on N74’s Excludes1 list, so N74 is never added alongside it.

Scenario 2: Positive chlamydia test, PID documented

Chart note: “NAAT positive for Chlamydia trachomatis. Clinical findings consistent with chlamydial PID, salpingitis confirmed on ultrasound. Chlamydial pelvic inflammatory disease.”
Code assignment: A56.11 alone (chlamydial female pelvic inflammatory disease). Same rule as Scenario 1. This is an Excludes1 condition, so it is never paired with N74.

Scenario 3: PID with no confirmed organism

Chart note: “Pelvic inflammatory disease, acute. Organism not identified.”
Code assignment: N73.9 (female pelvic inflammatory disease, unspecified). With no documented underlying disease, there is nothing to code first, so N74 does not apply.

Scenario 4: PID secondary to a disease outside the Excludes1 list

Chart note: “Long-standing IUD in place. Pelvic actinomycosis confirmed on culture. Pelvic inflammatory disease secondary to actinomycosis.”
Code assignment: A42.1 or A42.9 (actinomycosis, first), then N74 (second). Actinomycosis is not one of N74’s ten Excludes1 conditions, so this is the genuine Code first pairing the tabular list is describing.

Scenario 4 is the one pelvic health practices and gynecology coders miss most often. It runs against the instinct built up from Scenarios 1 and 2. The reflex to reach for an etiology-plus-N74 pair is correct only when that etiology isn’t already excluded. One documentation checklist question prevents both mistakes. Ask whether the underlying cause is one of the ten Excludes1 conditions, or something else entirely. Many pelvic health practices build that question straight into their intake forms.

What the chart needs to say before you code N74

Accurate N74 coding depends on what the treating clinician documents, not just the diagnosis. These are the elements coders and clinical documentation specialists need confirmed in the chart before selecting N74.

Practices using digital clinical forms can structure encounter templates to prompt clinicians for these elements at the point of documentation. That cuts the need for retrospective queries that delay claim submission.

Well-structured patient records that capture the underlying disease and the causal relationship make N74 selection straightforward for coders.

Practices concerned with HIPAA-compliant documentation workflows can review options for HIPAA compliance software.

How Pabau helps practices get N74 documentation right

Coding failures for N74 almost always start in the documentation, not the billing system. A clinician who writes “pelvic inflammatory disease” without naming the cause, or without ruling out the ten Excludes1 conditions, leaves the coder guessing.

Practice management software like Pabau addresses this directly. Its structured client record system captures the diagnosis relationship at the point of care, so the coder isn’t reconstructing it later at billing.

Pabau’s claims management software doesn’t check ICD-10 code-pairing logic itself. It does validate the insurer-submission fields a claim needs, and it gates the Send action until those fields are complete. A claim-status dashboard then tracks what’s been submitted and what’s still outstanding.

For gynecology, sexual health, and pelvic health practices, this catches the administrative slip-ups. A missing field or an incomplete submission gets stopped before it leaves the building. The coder still owns the clinical call. Confirming N74’s Code first partner, and ruling out an Excludes1 condition, stays a documentation task, not a system check.

Echo AI, Pabau’s AI scribe, records and structures clinical notes during the encounter. That supports the documentation specificity N74 coding requires:

• A named underlying disease
• A stated causal link to the pelvic presentation
• The lab or culture result behind it

Gynecology and women’s health practices often track these billing workflows across multiple providers or locations. Multi-location reporting through Pabau gives practice managers that visibility, across every site, in one place.

Keep every N74 claim submission-ready

Pabau's claims management software checks that every required field is filled in before a claim can be sent, and flags what's missing. That keeps incomplete pelvic inflammatory disease claims from stalling at the payer.

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Conclusion

N74 rewards the coder who treats it as one half of a pair, not a stand-alone diagnosis. Check that pair against the Excludes1 list before it goes anywhere near a claim. The habit worth building isn’t memorizing every excluded condition. It’s asking two questions in order: what caused the pelvic inflammatory finding, and does that cause already have its own dedicated code? Get that sequence right, and most of the denials and audit flags tied to this code disappear.

Pabau’s clinical documentation tools help practices capture the etiology at the encounter level. Claims management keeps the submission fields in check before the claim goes out. Book a demo to see how Pabau supports accurate, audit-ready ICD-10 coding for pelvic inflammatory disease claims.

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