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v1.0.0
ICD-10 Guide
ICD-10 CodesO16.3

O16.3

Billable

Unspecified maternal hypertension, third trimester

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O16.3 is a billable code used to indicate a diagnosis of unspecified maternal hypertension, third trimester.

Key Diagnostic Point:

Unspecified maternal hypertension in the third trimester refers to elevated blood pressure readings in pregnant women during the late stages of pregnancy, typically after 28 weeks gestation. This condition is characterized by systolic blood pressure readings of 140 mmHg or higher and/or diastolic readings of 90 mmHg or higher, without a clear diagnosis of preeclampsia or gestational hypertension. The condition may arise due to various factors, including pre-existing hypertension, obesity, or other underlying health issues. It is crucial for healthcare providers to monitor the mother closely, as uncontrolled hypertension can lead to serious complications such as placental abruption, fetal growth restriction, and increased risk of cesarean delivery. Diagnostic workup may include regular blood pressure monitoring, urinalysis to check for proteinuria, and blood tests to assess liver and kidney function. Management strategies often involve lifestyle modifications, medication adjustments, and careful monitoring of both maternal and fetal well-being.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in blood pressure readings and definitions of hypertension.
  • Need for differentiation from other hypertensive disorders in pregnancy.
  • Potential for coexisting conditions that complicate diagnosis.
  • Documentation requirements for monitoring and management plans.

Audit Risk Factors

  • Inadequate documentation of blood pressure readings.
  • Failure to document the management plan for hypertension.
  • Misclassification of hypertension type (e.g., gestational vs. chronic).
  • Lack of follow-up notes on maternal and fetal health.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of blood pressure readings, treatment plans, and follow-up assessments.

Common Clinical Scenarios

Routine prenatal visits where hypertension is identified, management of hypertensive crises.

Billing Considerations

Consideration of maternal history and risk factors for hypertension.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessments of maternal and fetal health, including ultrasound findings and laboratory results.

Common Clinical Scenarios

Management of high-risk pregnancies with pre-existing hypertension or complications.

Billing Considerations

In-depth monitoring and intervention strategies for both mother and fetus.

Coding Guidelines

Inclusion Criteria

Use O16.3 When
  • Follow the official ICD
  • CM guidelines for obstetric coding, ensuring accurate documentation of the trimester and specific hypertension type
  • Use additional codes as necessary to capture any associated conditions

Exclusion Criteria

Do NOT use O16.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used during routine prenatal visits for monitoring hypertension.

Documentation Requirements

Document blood pressure readings and any changes in management.

Specialty Considerations

Obstetricians should ensure thorough documentation of maternal health status.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal hypertension, improving the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal hypertension, improving the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal hypertension, improving the ability to track and manage these conditions effectively.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What is the difference between unspecified maternal hypertension and gestational hypertension?

Unspecified maternal hypertension refers to elevated blood pressure without a clear diagnosis of gestational hypertension or preeclampsia, while gestational hypertension is specifically diagnosed when hypertension develops after 20 weeks of pregnancy without proteinuria.