O03.1
BillableDelayed or excessive hemorrhage following incomplete spontaneous abortion
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O03.1 an HCC code?
No. O03.1 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
O03.1 is the ICD-10-CM diagnosis code for delayed or excessive hemorrhage following incomplete spontaneous abortion. Excessive or prolonged bleeding following an incomplete miscarriage, or bleeding that occurs later than expected after the pregnancy loss. O03.1 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).
O03.1 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 quantification of blood loss (estimated or measured) and whether transfusion or intervention was required.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O03.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document quantification of blood loss (estimated or measured) and whether transfusion or intervention was required
- •Distinguish between immediate hemorrhage and delayed hemorrhage occurring days after the incomplete abortion