Question 1

What is ICD-10 code O88.311?

Accepted Answer

O88.311 is the ICD-10-CM diagnosis code for pyemic and septic embolism in pregnancy, first trimester. A serious bloodstream infection with septic particles and clots that develops during the first three months of pregnancy, potentially causing life-threatening complications. O88.311 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering complications predominantly related to the puerperium (o85-o92).

O88.311 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28, V24, ESRD, or RxHCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.

Verify first trimester documentation (weeks 1-13); select appropriate trimester code if different timing is documented.

Question 2

Is O88.311 an HCC code?

Accepted Answer

No. O88.311 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 O88.311 billable?

Accepted Answer

Yes. O88.311 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. O88.311 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

Which HCC does O88.311 map to under V28?

Accepted Answer

O88.311 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What RAF reference is published for O88.311?

Accepted Answer

O88.311 has no separately stated V28 community reference coefficient. Check the current CMS mapping and factor files before using it in any member-score workflow.

Question 6

What is the V28 vs V24 difference for O88.311?

Accepted Answer

O88.311 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 O88.311 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 7

What documentation supports O88.311?

Accepted Answer

Verify first trimester documentation (weeks 1-13); select appropriate trimester code if different timing is documented Document the source of infection and any organisms identified to support medical necessity and guide treatment O88.311 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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O88.311

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O88.311 ICD-10-CM Code: Pyemic and septic embolism in pregnancy, first trimester

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O88.311

Is O88.311 an HCC code?

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What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work O88.311 in HCC Buddy