Question 1

What is ICD-10 code O9A.111?

Accepted Answer

O9A.111 is the ICD-10-CM diagnosis code for malignant neoplasm complicating pregnancy, first trimester. A pregnant woman has been diagnosed with cancer (malignant neoplasm) during the first trimester of pregnancy. O9A.111 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).

O9A.111 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.

Always specify the trimester; first trimester is weeks 1-13 of pregnancy.

Question 2

Is O9A.111 an HCC code?

Accepted Answer

No. O9A.111 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 O9A.111 billable?

Accepted Answer

Yes. O9A.111 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. O9A.111 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

What is the V28 vs V24 difference for O9A.111?

Accepted Answer

O9A.111 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 model rewards O9A.111 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting O9A.111?

Accepted Answer

Always specify the trimester; first trimester is weeks 1-13 of pregnancy Use an additional code to identify the specific type and site of the malignant neoplasm (e.g., C50 for breast cancer)

O9A.111

Is O9A.111 an HCC code?

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