Question 1

What is ICD-10 code O46.009?

Accepted Answer

O46.009 is the ICD-10-CM diagnosis code for antepartum hemorrhage with coagulation defect, unspecified, unspecified trimester. Bleeding during pregnancy caused by an unspecified blood clotting disorder when the specific trimester of pregnancy is not documented. O46.009 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).

O46.009 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.

Use this code only when trimester information is unavailable or unclear in the medical record.

Question 2

Is O46.009 an HCC code?

Accepted Answer

No. O46.009 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 O46.009 billable?

Accepted Answer

Yes. O46.009 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. O46.009 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 O46.009?

Accepted Answer

O46.009 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 O46.009 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 O46.009?

Accepted Answer

Use this code only when trimester information is unavailable or unclear in the medical record Query the provider if trimester can be determined from delivery date or other clinical documentation

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O46.009

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O46.009 ICD-10-CM Code: Antepartum hemorrhage with coagulation defect, unspecified, unspecified trimester

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O46.009

Is O46.009 an HCC code?

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Work O46.009 in HCC Buddy