O98.713 ICD-10-CM Code: Human immunodeficiency virus [HIV] disease complicating pregnancy, third trimester
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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Other obstetric conditions, not elsewhere classified (O94-O9A)
O98.713
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHuman immunodeficiency virus [HIV] disease complicating pregnancy, third trimester
HIV infection in a pregnant person during the final three months of pregnancy. Close monitoring is essential during this period to prepare for delivery and prevent transmission to the newborn.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
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Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for O98.713 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for O98.713 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for O98.713 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for O98.713 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for O98.713 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for O98.713 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for O98.713 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is O98.713 an HCC code?
No. O98.713 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O98.713 is the ICD-10-CM diagnosis code for human immunodeficiency virus [hiv] disease complicating pregnancy, third trimester. HIV infection in a pregnant person during the final three months of pregnancy. Close monitoring is essential during this period to prepare for delivery and prevent transmission to the newborn. O98.713 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering other obstetric conditions, not elsewhere classified (o94-o9a).
O98.713 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.
Verify third trimester documentation; this code is critical for delivery planning and neonatal prophylaxis decisions.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.713 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify third trimester documentation; this code is critical for delivery planning and neonatal prophylaxis decisions
- •Ensure viral load status near delivery is documented for transmission risk assessment