Question 1

What is ICD-10 code O46.003?

Accepted Answer

O46.003 is the ICD-10-CM diagnosis code for antepartum hemorrhage with coagulation defect, unspecified, third trimester. Bleeding during pregnancy in the third trimester caused by an unspecified blood clotting disorder that prevents normal clot formation. O46.003 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).

O46.003 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.

Confirm third trimester documentation (weeks 21 through delivery) in the clinical notes.

Question 2

Is O46.003 an HCC code?

Accepted Answer

No. O46.003 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 O46.003 billable?

Accepted Answer

Yes. O46.003 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. O46.003 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 O46.003?

Accepted Answer

O46.003 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 community model rewards O46.003 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting O46.003?

Accepted Answer

Confirm third trimester documentation (weeks 21 through delivery) in the clinical notes This code should only be used when the type of coagulation defect is not further specified in the record

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O46.003

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O46.003 ICD-10-CM Code: Antepartum hemorrhage with coagulation defect, unspecified, third trimester

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O46.003

Is O46.003 an HCC code?

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