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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.21

O26.21

Billable

Pregnancy care for patient with recurrent pregnancy loss, first trimester

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

Code Description

ICD-10 O26.21 is a billable code used to indicate a diagnosis of pregnancy care for patient with recurrent pregnancy loss, first trimester.

Key Diagnostic Point:

O26.21 is used to document care for pregnant patients experiencing recurrent pregnancy loss during the first trimester. This condition is characterized by two or more consecutive pregnancy losses before 20 weeks of gestation. The management of these patients often involves a multidisciplinary approach, including obstetricians, maternal-fetal medicine specialists, and possibly other specialists depending on underlying conditions. Care may include thorough evaluation for potential causes such as anatomical abnormalities, hormonal imbalances, autoimmune disorders, and genetic factors. Patients may require additional monitoring and supportive care, including counseling and possibly interventions to improve pregnancy outcomes. The first trimester is a critical period for fetal development, and addressing recurrent pregnancy loss is essential for maternal and fetal health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for comprehensive patient history and documentation of previous losses
  • Potential involvement of multiple specialties for management
  • Variability in underlying causes requiring tailored care plans
  • Documentation of additional tests and interventions

Audit Risk Factors

  • Inadequate documentation of previous pregnancy losses
  • Failure to document the multidisciplinary approach to care
  • Misclassification of the trimester of pregnancy
  • Lack of supporting evidence for additional diagnostic tests

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed history of pregnancy losses, current pregnancy status, and any interventions undertaken.

Common Clinical Scenarios

Patients with a history of multiple miscarriages presenting for early pregnancy monitoring.

Billing Considerations

Ensure all relevant tests and consultations are documented to support the diagnosis.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive evaluation of risk factors, including genetic testing and imaging studies.

Common Clinical Scenarios

High-risk patients with recurrent pregnancy loss requiring specialized monitoring.

Billing Considerations

Focus on the management of underlying conditions that may contribute to pregnancy loss.

Coding Guidelines

Inclusion Criteria

Use O26.21 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the patient's history of pregnancy loss and any relevant clinical findings
  • The code should be used in conjunction with any other applicable codes for co
  • existing conditions

Exclusion Criteria

Do NOT use O26.21 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 for patients with recurrent pregnancy loss.

Documentation Requirements

Document history of previous losses and current pregnancy status.

Specialty Considerations

Ensure that the visit is clearly linked to the management of recurrent pregnancy loss.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, improving the ability to capture the complexity of these cases and ensuring better tracking of patient outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, improving the ability to capture the complexity of these cases and ensuring better tracking of patient outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, improving the ability to capture the complexity of these cases and ensuring better tracking of patient 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 documentation is required for coding O26.21?

Documentation must include a detailed history of previous pregnancy losses, current pregnancy status, and any relevant diagnostic tests or interventions undertaken.