O43.013
BillableFetomaternal placental transfusion syndrome, third trimester
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O43.013 an HCC code?
No. O43.013 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
O43.013 is the ICD-10-CM diagnosis code for fetomaternal placental transfusion syndrome, third trimester. An abnormal transfer of blood occurs from the fetus to the mother through the placenta during the third trimester of pregnancy. O43.013 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).
O43.013 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 is the most common trimester for detection of fetomaternal transfusion.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O43.013 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is the most common trimester for detection of fetomaternal transfusion
- •Document any testing performed such as Kleihauer-Betke test or flow cytometry