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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.0

O26.0

Billable

Excessive weight gain in pregnancy

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

Code Description

ICD-10 O26.0 is a billable code used to indicate a diagnosis of excessive weight gain in pregnancy.

Key Diagnostic Point:

Excessive weight gain during pregnancy is defined as weight gain that exceeds the recommended guidelines set forth by the Institute of Medicine (IOM). This condition can complicate pregnancy and lead to various maternal and fetal health issues, including gestational diabetes, hypertension, and increased risk of cesarean delivery. It is crucial for healthcare providers to monitor weight gain throughout pregnancy, as excessive weight can exacerbate pre-existing conditions such as renal, cardiac, and respiratory issues. For instance, women with pre-existing cardiac conditions may experience increased strain on the heart due to excessive weight gain, while those with renal issues may face challenges in fluid management. Additionally, respiratory complications can arise as weight gain may lead to increased pressure on the diaphragm, affecting lung capacity. Proper documentation of weight gain, along with any associated complications, is essential for accurate coding and management of care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in recommended weight gain based on pre-pregnancy BMI.
  • Need for comprehensive documentation of maternal health conditions.
  • Potential overlap with other pregnancy-related complications.
  • Variability in clinical guidelines and recommendations.

Audit Risk Factors

  • Inadequate documentation of weight gain measurements.
  • Failure to document associated maternal health conditions.
  • Misclassification of weight gain categories.
  • Lack of clear clinical rationale for weight gain assessment.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include pre-pregnancy BMI, weight gain at each visit, and any complications arising from excessive weight gain.

Common Clinical Scenarios

A patient presenting with excessive weight gain and developing gestational diabetes or hypertension.

Billing Considerations

Consider the patient's overall health, including any pre-existing conditions that may be affected by weight gain.

Maternal-Fetal Medicine

Documentation Requirements

Detailed documentation of maternal and fetal health, including any interventions required due to excessive weight gain.

Common Clinical Scenarios

Management of a high-risk pregnancy where excessive weight gain is noted alongside other complications.

Billing Considerations

Focus on the impact of excessive weight gain on fetal development and maternal health.

Coding Guidelines

Inclusion Criteria

Use O26.0 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring accurate documentation of weight gain and any related complications
  • Use additional codes to specify any associated conditions

Exclusion Criteria

Do NOT use O26.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

59400CPT Code

Obstetrical care, including antepartum care, delivery, and postpartum care

Clinical Scenario

Used for comprehensive obstetric care when managing excessive weight gain.

Documentation Requirements

Document all visits, weight measurements, and any complications.

Specialty Considerations

Ensure that all aspects of care are documented to support the coding of O26.0.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like excessive weight gain in pregnancy, improving the ability to track and manage maternal health outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like excessive weight gain in pregnancy, improving the ability to track and manage maternal health outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like excessive weight gain in pregnancy, improving the ability to track and manage maternal health outcomes.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What constitutes excessive weight gain in pregnancy?

Excessive weight gain is defined as weight gain that exceeds the recommended guidelines based on pre-pregnancy BMI, which can lead to various complications for both mother and baby.