Question 1

What is ICD-10 code O99.333?

Accepted Answer

O99.333 is the ICD-10-CM diagnosis code for smoking (tobacco) complicating pregnancy, third trimester. A pregnant woman who smokes tobacco during the third trimester (last three months of pregnancy), which can affect the developing baby and pregnancy outcomes. O99.333 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).

O99.333 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 the trimester is documented as third trimester; if trimester is not specified, use O99.330 instead.

Question 2

Is O99.333 an HCC code?

Accepted Answer

No. O99.333 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 O99.333 billable?

Accepted Answer

Yes. O99.333 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. O99.333 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 O99.333 map to under V28?

Accepted Answer

O99.333 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 does O99.333 pay in RAF?

Accepted Answer

O99.333 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for O99.333?

Accepted Answer

O99.333 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 O99.333 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 O99.333?

Accepted Answer

Verify the trimester is documented as third trimester; if trimester is not specified, use O99.330 instead This code indicates maternal smoking as a complication; document the patient's smoking status and any counseling provided O99.333 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.

HCC Buddy Code Card

O99.333

Is O99.333 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work O99.333 in HCC Buddy

O99.333 ICD-10-CM Code: Smoking (tobacco) complicating pregnancy, third trimester

HCC Buddy Code Card

O99.333

Is O99.333 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work O99.333 in HCC Buddy