O23.02 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupO23.02

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Other maternal disorders predominantly related to pregnancy (O20-O29)

O23.02

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Infections of kidney in pregnancy, second trimester

A kidney infection that develops during the second trimester (weeks 13-27) of pregnancy.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Context needed

HCC 212

Conditional HHS-HCC mapping: HCC 212 when 9 <= age <= 64. Select the member context before showing a coefficient reference. Metal level and model segment are required for coefficients; no single RAF is shown.

Coefficient needs member context

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

O23Infections of genitourinary tract in pregnancy O23.0Infections of kidney in pregnancy O23.02Infections of kidney in pregnancy, second trimester

Inclusion Terms

Official

Pyelonephritis in pregnancyInherited from O23.0

Excludes 2

Official

mental and behavioral disorders associated with the puerperium (F53.-)Inherited from O00-O9A, O20-O29, O23
obstetrical tetanus (A34)Inherited from O00-O9A, O20-O29, O23
postpartum necrosis of pituitary gland (E23.0)Inherited from O00-O9A, O20-O29, O23
puerperal osteomalacia (M83.0)Inherited from O00-O9A, O20-O29, O23
maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)Inherited from O00-O9A, O20-O29, O23
maternal diseases classifiable elsewhere but complicating pregnancy, labor and delivery, and the puerperium (O98-O99)Inherited from O00-O9A, O20-O29, O23
gonococcal infections complicating pregnancy, childbirth and the puerperium (O98.2)Inherited from O00-O9A, O20-O29, O23
infections with a predominantly sexual mode of transmission NOS complicating pregnancy, childbirth and the puerperium (O98.3)Inherited from O00-O9A, O20-O29, O23
syphilis complicating pregnancy, childbirth and the puerperium (O98.1)Inherited from O00-O9A, O20-O29, O23
tuberculosis of genitourinary system complicating pregnancy, childbirth and the puerperium (O98.0)Inherited from O00-O9A, O20-O29, O23
venereal disease NOS complicating pregnancy, childbirth and the puerperium (O98.3)Inherited from O00-O9A, O20-O29, O23

Related Codes

Official

O23.00Infections of kidney in pregnancy, unspecified trimester O23.01Infections of kidney in pregnancy, first trimester O23.03Infections of kidney in pregnancy, third trimester

Includes

Official

No Includes notes are included in this display for O23.02. Check the code and parent instructions in the Code Book.

Excludes 1

Official

supervision of normal pregnancy (Z34.-)Inherited from O00-O9A

Code First

Official

No Code First sequencing instructions are included in this display for O23.02. Check the code and parent instructions in the Code Book.

Use Additional

Official

code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.Inherited from O00-O9A, O23
code to identify organism (B95.-, B96.-)Inherited from O00-O9A, O23

Code Also

Official

No Code Also instructions are included in this display for O23.02. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Always verify the trimester is documented in the medical record; if not specified, use O23.00 instead

This code requires a pregnancy diagnosis code (Z3x.xx) to fully describe the clinical picture

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is O23.02 an HCC code?

Code: O23.02
Description: Infections of kidney in pregnancy, second trimester
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

Coder workflow notes

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What This Code Means

O23.02 is the ICD-10-CM diagnosis code for infections of kidney in pregnancy, second trimester. A kidney infection that develops during the second trimester (weeks 13-27) of pregnancy. O23.02 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering other maternal disorders predominantly related to pregnancy (o20-o29).

O23.02 has no mapping under the current CMS-HCC V28 community payment model. O23.02 also appears in the HHS-HCC commercial risk model (HCC 212 (HHS-HCC 212 adult, RAF varies by metal level)), where the result depends on member context and is not a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

Always verify the trimester is documented in the medical record; if not specified, use O23.00 instead.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for O23.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Always verify the trimester is documented in the medical record; if not specified, use O23.00 instead
•This code requires a pregnancy diagnosis code (Z3x.xx) to fully describe the clinical picture