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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.5

O26.5

Billable

Maternal hypotension syndrome

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

Code Description

ICD-10 O26.5 is a billable code used to indicate a diagnosis of maternal hypotension syndrome.

Key Diagnostic Point:

Maternal hypotension syndrome refers to a condition characterized by abnormally low blood pressure in pregnant women, which can lead to inadequate blood flow to vital organs and the placenta. This syndrome can complicate pregnancy, particularly in women with pre-existing conditions such as cardiac, renal, or respiratory disorders. The condition may manifest as dizziness, fainting, or fatigue, and can be exacerbated by factors such as dehydration, prolonged standing, or certain medications. In obstetric care, monitoring maternal blood pressure is crucial, especially during the second and third trimesters when physiological changes can lead to hypotension. Management may involve lifestyle modifications, hydration, and in some cases, medication adjustments. Understanding the implications of maternal hypotension is essential for ensuring both maternal and fetal well-being, as severe cases can lead to complications such as fetal distress or preterm labor.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary hypotension and secondary causes related to pregnancy.
  • Understanding the interplay between maternal hypotension and other comorbid conditions.
  • The need for comprehensive documentation of symptoms and management strategies.
  • Variability in clinical presentation and management across different healthcare settings.

Audit Risk Factors

  • Inadequate documentation of maternal symptoms and clinical findings.
  • Failure to capture relevant comorbid conditions that may influence hypotension.
  • Misclassification of hypotension severity leading to incorrect coding.
  • Lack of follow-up documentation regarding management and outcomes.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal blood pressure readings, symptoms, and interventions.

Common Clinical Scenarios

Management of hypotension during routine prenatal visits or labor.

Billing Considerations

Consideration of the impact of maternal hypotension on fetal monitoring and delivery planning.

Maternal-Fetal Medicine

Documentation Requirements

Thorough documentation of high-risk factors, including cardiac and renal history.

Common Clinical Scenarios

Monitoring and managing hypotension in patients with pre-existing conditions.

Billing Considerations

In-depth evaluation of maternal-fetal interactions and potential complications.

Coding Guidelines

Inclusion Criteria

Use O26.5 When
  • 10 coding guidelines for O26
  • 5 require accurate documentation of maternal hypotension symptoms, associated conditions, and management strategies
  • Coders should ensure that the diagnosis is supported by clinical findings and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use O26.5 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 maternal hypotension.

Documentation Requirements

Document blood pressure readings, symptoms, and management plans.

Specialty Considerations

Obstetricians should ensure comprehensive assessments are recorded.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including hypotension, which enhances the ability to track and manage these complications effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including hypotension, which enhances the ability to track and manage these complications effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal conditions, including hypotension, which enhances the ability to track and manage these complications effectively.

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 common causes of maternal hypotension syndrome?

Common causes include dehydration, prolonged standing, certain medications, and physiological changes during pregnancy. It is essential to monitor blood pressure regularly and manage any underlying conditions.