O43.192
BillableOther malformation of placenta, second trimester
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O43.192 an HCC code?
No. O43.192 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
O43.192 is the ICD-10-CM diagnosis code for other malformation of placenta, second trimester. The placenta has an abnormal structure or formation other than velamentous insertion or accreta, identified during the second trimester of pregnancy. O43.192 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).
O43.192 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.
Document the specific nature of the placental malformation for clinical clarity.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O43.192 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific nature of the placental malformation for clinical clarity
- •Confirm second trimester dating (weeks 14-20) is documented