O99.513 ICD-10-CM Code: Diseases of the respiratory system 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)
O99.513
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceDiseases of the respiratory system complicating pregnancy, third trimester
A lung or breathing condition that occurs during the final three months of pregnancy (weeks 27 to delivery) and affects the pregnancy.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 212
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for O99.513 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for O99.513 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for O99.513 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for O99.513 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for O99.513 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for O99.513 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for O99.513 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 O99.513 an HCC code?
No. O99.513 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- O99.513
- Description
- Diseases of the respiratory system complicating pregnancy, third trimester
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
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
O99.513 is the ICD-10-CM diagnosis code for diseases of the respiratory system complicating pregnancy, third trimester. A lung or breathing condition that occurs during the final three months of pregnancy (weeks 27 to delivery) and affects the pregnancy. O99.513 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).
O99.513 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.
Confirm third trimester documentation; this period extends from week 27 through delivery.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O99.513 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm third trimester documentation; this period extends from week 27 through delivery
- •Ensure the respiratory condition is clearly documented as complicating the pregnancy