O98.72
BillableHuman immunodeficiency virus [HIV] disease complicating childbirth
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is O98.72 an HCC code?
No. O98.72 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O98.72 is the ICD-10-CM diagnosis code for human immunodeficiency virus [hiv] disease complicating childbirth. HIV infection in a person during labor and delivery. Special precautions and medical management are necessary during childbirth to reduce the risk of transmitting HIV to the newborn. O98.72 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).
O98.72 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 with appropriate delivery outcome codes (Z37.x series).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O98.72 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use with appropriate delivery outcome codes (Z37.x series)
- •Document viral load status at delivery and any intrapartum interventions to prevent transmission