ICD-10 O43.011
Billable / SpecificFetomaternal placental transfusion syndrome, first trimester
About ICD-10-CM O43.011
ICD-10-CM code O43.011 represents Fetomaternal placental transfusion syndrome, first trimester. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O43). The 2026 edition of ICD-10-CM O43.011 became effective on October 1, 2025.
Coding Tips for O43.011
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Medicare LCD Coverage for O43.011
Local Coverage Determinations (LCDs) from CMS MACs that list O43.011 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O43.011.
3 Aetna
1 Cigna
CPT Codes Commonly Billed with O43.011
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert O43.011 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| O43.011 | 65601 | 10000 |
| O43.011 | 65603 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O43.011
Other codes in section O30-O48 (Maternal care related to the fetus and amniotic cavity and possible delivery problems).
ICD-10 O43.011, Billing FAQ
Is ICD-10 code O43.011 billable? +
Yes, O43.011 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What ICD-9 codes does O43.011 map to? +
Per CMS GEMs, O43.011 maps to ICD-9 codes: 65601, 65603. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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