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ICD-10 Guide
ICD-10 CodesO26.11

O26.11

Billable

Low weight gain in pregnancy, first trimester

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

Code Description

ICD-10 O26.11 is a billable code used to indicate a diagnosis of low weight gain in pregnancy, first trimester.

Key Diagnostic Point:

Low weight gain in pregnancy during the first trimester can be indicative of various underlying health issues that may complicate maternal and fetal health. This condition is characterized by insufficient weight gain, which is typically defined as less than 1.1 kg (2.5 lbs) during the first trimester. It can be associated with inadequate caloric intake, hyperemesis gravidarum, or underlying medical conditions such as renal, cardiac, or respiratory disorders. Maternal health is crucial during this period, as low weight gain can lead to adverse outcomes such as preterm birth, low birth weight, and developmental issues for the fetus. Close monitoring and intervention are essential to address nutritional needs and manage any complicating conditions. Healthcare providers should assess dietary habits, perform regular weight checks, and consider referrals to nutritionists or specialists if necessary. The management of low weight gain should be tailored to the individual, taking into account any existing health conditions that may affect weight and overall pregnancy health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between normal and abnormal weight gain patterns.
  • Identifying and documenting underlying medical conditions.
  • Understanding the implications of low weight gain on fetal development.
  • Navigating the coding guidelines for multiple conditions.

Audit Risk Factors

  • Inadequate documentation of weight gain measurements.
  • Failure to document underlying conditions affecting weight.
  • Misclassification of weight gain as normal when it is not.
  • Lack of follow-up documentation on interventions or referrals.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of weight gain, dietary assessments, and any interventions.

Common Clinical Scenarios

Patients with hyperemesis gravidarum, dietary restrictions, or chronic illnesses.

Billing Considerations

Ensure comprehensive documentation of maternal health status and any referrals made.

Maternal-Fetal Medicine

Documentation Requirements

Thorough documentation of high-risk factors and multidisciplinary care plans.

Common Clinical Scenarios

Pregnancies complicated by renal disease, cardiac conditions, or severe respiratory issues.

Billing Considerations

Focus on the impact of maternal conditions on fetal growth and development.

Coding Guidelines

Inclusion Criteria

Use O26.11 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring accurate documentation of weight gain and any complicating factors
  • Use additional codes for underlying conditions as necessary

Exclusion Criteria

Do NOT use O26.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

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

Documentation Requirements

Document weight measurements, dietary assessments, and any referrals.

Specialty Considerations

Ensure that the visit is clearly linked to the management of low weight gain.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage low weight gain in pregnancy. This specificity aids in better patient care and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage low weight gain in pregnancy. This specificity aids in better patient care and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage low weight gain in pregnancy. This specificity aids in better patient care and resource allocation.

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 should be documented to support the use of code O26.11?

Documentation should include the patient's weight gain measurements, any dietary assessments, underlying health conditions, and interventions taken to address low weight gain.