O16.4
BillableUnspecified maternal hypertension, complicating childbirth
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O16.4 an HCC code?
No. O16.4 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
O16.4 is the ICD-10-CM diagnosis code for unspecified maternal hypertension, complicating childbirth. High blood pressure in a pregnant woman that is present during labor and delivery, without a specific underlying cause identified. O16.4 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (o10-o16).
O16.4 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.
This code captures hypertension occurring during the intrapartum period (active labor and delivery).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O16.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code captures hypertension occurring during the intrapartum period (active labor and delivery)
- •If hypertension continues postpartum, use O16.5 instead