O03.0
BillableGenital tract and pelvic infection following incomplete spontaneous abortion
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O03.0 an HCC code?
No. O03.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O03.0 is the ICD-10-CM diagnosis code for genital tract and pelvic infection following incomplete spontaneous abortion. An infection of the reproductive tract and pelvic area following an incomplete miscarriage where some pregnancy tissue remains in the uterus. O03.0 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering pregnancy with abortive outcome (o00-o08).
O03.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document the specific type of infection (bacterial, fungal, etc.) if identified through culture or clinical findings.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O03.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of infection (bacterial, fungal, etc.) if identified through culture or clinical findings
- •Ensure that the abortion is documented as incomplete and that infection is confirmed before coding