Question 1

What is ICD-10 code O30.211?

Accepted Answer

O30.211 is the ICD-10-CM diagnosis code for Quadruplet pregnancy with two or more monochorionic fetuses, first trimester. A pregnancy with four fetuses where at least two of them share a single placenta, occurring in the first trimester. O30.211 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. O30.211 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Question 2

Is O30.211 an HCC code?

Accepted Answer

No. O30.211 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is O30.211 billable?

Accepted Answer

Yes. O30.211 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. O30.211 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for O30.211?

Accepted Answer

O30.211 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards O30.211 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting O30.211?

Accepted Answer

Monochorionic fetuses share a placenta and carry increased risks for complications; ensure this finding is clearly documented in imaging reports This more specific code provides better clinical detail than the unspecified O30.20x codes

O30.211

Is O30.211 an HCC code?

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