Question 1

What is ICD-10 code O88.319?

Accepted Answer

O88.319 is the ICD-10-CM diagnosis code for pyemic and septic embolism in pregnancy, unspecified trimester. A serious blood clot infection (septic embolism) during pregnancy when the specific trimester is not documented or specified. O88.319 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).

O88.319 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.

Use this code only when the trimester cannot be determined from the medical record.

Question 2

Is O88.319 an HCC code?

Accepted Answer

No. O88.319 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 O88.319 billable?

Accepted Answer

Yes. O88.319 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. O88.319 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 O88.319 map to under V28?

Accepted Answer

O88.319 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 O88.319?

Accepted Answer

O88.319 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 O88.319?

Accepted Answer

O88.319 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 O88.319 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 O88.319?

Accepted Answer

Use this code only when the trimester cannot be determined from the medical record Query the provider if trimester information is available to assign a more specific code O88.319 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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O88.319

Is O88.319 an HCC code?

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O88.319 ICD-10-CM Code: Pyemic and septic embolism in pregnancy, unspecified trimester

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O88.319

Is O88.319 an HCC code?

Get the V28 mapping + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work O88.319 in HCC Buddy