O34.22 ICD-10-CM Code: Maternal care for cesarean scar defect (isthmocele)
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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)
O34.22
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMaternal care for cesarean scar defect (isthmocele)
Pregnant patient with a defect in the cesarean scar (isthmocele), which is a cavity or weakness in the lower uterine segment from previous cesarean delivery.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 211
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for O34.22 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for O34.22 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for O34.22 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for O34.22 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for O34.22 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for O34.22 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for O34.22 in this effective period.
Buddy Documentation Tip
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 O34.22 an HCC code?
No. O34.22 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- O34.22
- Description
- Maternal care for cesarean scar defect (isthmocele)
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O34.22 is the ICD-10-CM diagnosis code for maternal care for cesarean scar defect (isthmocele). Pregnant patient with a defect in the cesarean scar (isthmocele), which is a cavity or weakness in the lower uterine segment from previous cesarean delivery. O34.22 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering maternal care related to the fetus and amniotic cavity and possible delivery problems (o30-o48).
O34.22 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.
Isthmocele is a specific complication of cesarean scar; document presence of defect clearly.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O34.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Isthmocele is a specific complication of cesarean scar; document presence of defect clearly
- •This code does not require trimester specification as written, but verify payer requirements