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ICD-10 Guide
ICD-10 CodesO26.1

O26.1

Billable

Low weight gain in pregnancy

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

Code Description

ICD-10 O26.1 is a billable code used to indicate a diagnosis of low weight gain in pregnancy.

Key Diagnostic Point:

Low weight gain in pregnancy is a condition characterized by insufficient weight gain during gestation, which can have significant implications for both maternal and fetal health. Adequate weight gain is crucial for the development of the fetus and the overall health of the mother. Factors contributing to low weight gain may include maternal nutritional deficiencies, underlying medical conditions such as renal or cardiac issues, and psychosocial factors. In cases where the mother has renal complications, such as chronic kidney disease, the ability to maintain a healthy weight can be severely impacted due to dietary restrictions and fluid management. Similarly, cardiac conditions may limit physical activity and affect metabolic demands, leading to inadequate weight gain. Respiratory issues can also contribute to low weight gain by affecting the mother’s ability to consume adequate nutrition. Monitoring and addressing low weight gain is essential to prevent adverse outcomes such as intrauterine growth restriction (IUGR), preterm birth, and low birth weight. Healthcare providers must assess the underlying causes and implement appropriate interventions to support healthy weight gain throughout the pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between normal and abnormal weight gain based on gestational age.
  • Identifying and documenting underlying medical conditions that may contribute to low weight gain.
  • Understanding the implications of low weight gain on fetal development and maternal health.
  • Navigating the nuances of coding related complications and co-morbidities.

Audit Risk Factors

  • Inadequate documentation of maternal health conditions.
  • Failure to document the impact of low weight gain on fetal health.
  • Misclassification of weight gain status based on gestational age.
  • Lack of follow-up documentation regarding interventions and outcomes.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include maternal weight measurements, gestational age, and any underlying health conditions affecting weight gain.

Common Clinical Scenarios

A pregnant patient with a history of eating disorders presenting with low weight gain; a patient with chronic renal failure experiencing weight loss.

Billing Considerations

Consider the psychosocial aspects affecting weight gain, such as mental health issues or socioeconomic factors.

Maternal-Fetal Medicine

Documentation Requirements

Detailed records of maternal-fetal assessments, including ultrasounds and growth measurements.

Common Clinical Scenarios

Monitoring a high-risk pregnancy where low weight gain is noted alongside other complications.

Billing Considerations

Focus on the implications of low weight gain on fetal growth and development, requiring close monitoring.

Coding Guidelines

Inclusion Criteria

Use O26.1 When
  • Follow the official ICD
  • CM guidelines for obstetric coding, ensuring accurate documentation of weight gain in relation to gestational age and any complicating conditions

Exclusion Criteria

Do NOT use O26.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits to monitor weight gain and maternal health.

Documentation Requirements

Document weight measurements, maternal health assessments, and any interventions.

Specialty Considerations

Ensure that the visit is focused on obstetric care and includes relevant assessments.

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 low weight gain in pregnancy, improving the ability to capture the complexity of maternal health issues.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like low weight gain in pregnancy, improving the ability to capture the complexity of maternal health issues.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like low weight gain in pregnancy, improving the ability to capture the complexity of maternal health issues.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the implications of low weight gain during pregnancy?

Low weight gain can lead to complications such as intrauterine growth restriction, preterm birth, and low birth weight, necessitating close monitoring and intervention.