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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.23

O26.23

Billable

Pregnancy care for patient with recurrent pregnancy loss, third trimester

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

Code Description

ICD-10 O26.23 is a billable code used to indicate a diagnosis of pregnancy care for patient with recurrent pregnancy loss, third trimester.

Key Diagnostic Point:

O26.23 is used to document care for pregnant patients who have experienced recurrent pregnancy loss and are currently in their third trimester. This condition is characterized by the history of two or more consecutive pregnancy losses before the 20th week of gestation. In the third trimester, the focus shifts to monitoring the health of both the mother and the fetus, as well as addressing any complications that may arise due to the mother's underlying health conditions, such as renal, cardiac, or respiratory issues. Care may involve close surveillance of fetal growth, maternal vital signs, and laboratory tests to assess renal function, cardiac output, and respiratory status. The management plan often includes multidisciplinary collaboration among obstetricians, maternal-fetal medicine specialists, and other healthcare providers to ensure optimal outcomes for both mother and baby.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for detailed patient history regarding previous pregnancy losses
  • Management of coexisting maternal health conditions (renal, cardiac, respiratory)
  • Coordination of care among multiple specialties
  • Monitoring for potential complications in the third trimester

Audit Risk Factors

  • Inadequate documentation of recurrent pregnancy loss history
  • Failure to document coexisting conditions and their management
  • Lack of clear treatment plans and follow-up assessments
  • Misclassification of the trimester of pregnancy

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of pregnancy history, including previous losses, current health status, and any interventions performed.

Common Clinical Scenarios

Patients with a history of recurrent pregnancy loss presenting for routine prenatal care in the third trimester.

Billing Considerations

Ensure accurate coding of any complications arising from maternal health conditions.

Maternal-Fetal Medicine

Documentation Requirements

Thorough documentation of high-risk factors, including maternal comorbidities and their impact on pregnancy.

Common Clinical Scenarios

Management of patients with significant renal or cardiac issues during the third trimester.

Billing Considerations

Focus on the interdisciplinary approach to care and the need for specialized monitoring.

Coding Guidelines

Inclusion Criteria

Use O26.23 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring accurate documentation of the patient's history and current health status
  • Specific criteria for recurrent pregnancy loss must be met, including the number of losses and gestational age

Exclusion Criteria

Do NOT use O26.23 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

59400CPT Code

Obstetric care including antepartum care, delivery, and postpartum care

Clinical Scenario

Used for comprehensive care of a patient with recurrent pregnancy loss in the third trimester.

Documentation Requirements

Document all visits, assessments, and interventions related to the patient's care.

Specialty Considerations

Ensure coordination with maternal-fetal medicine specialists for high-risk cases.

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 capture the complexity of cases like O26.23, which reflects the nuances of recurrent pregnancy loss and its management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to capture the complexity of cases like O26.23, which reflects the nuances of recurrent pregnancy loss and its management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to capture the complexity of cases like O26.23, which reflects the nuances of recurrent pregnancy loss and its management.

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 O26.23?

Documentation must include a detailed history of previous pregnancy losses, current health status, any complications, and the management plan for the third trimester.