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ICD-10 Guide
ICD-10 CodesO01.1

O01.1

Billable

Incomplete and partial hydatidiform mole

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

Code Description

ICD-10 O01.1 is a billable code used to indicate a diagnosis of incomplete and partial hydatidiform mole.

Key Diagnostic Point:

An incomplete or partial hydatidiform mole is a type of gestational trophoblastic disease characterized by abnormal placental development and the presence of some fetal tissue. This condition arises when there is an abnormal fertilization event, leading to the formation of a placenta that is either partially developed or contains both normal and abnormal tissue. Clinically, patients may present with symptoms such as vaginal bleeding, elevated levels of human chorionic gonadotropin (hCG), and an enlarged uterus. Diagnosis is typically confirmed through ultrasound, which may reveal a heterogeneous mass within the uterus. The risk of developing choriocarcinoma, a malignant form of gestational trophoblastic disease, is a significant concern, necessitating careful monitoring of hCG levels post-diagnosis. Management often involves surgical intervention, such as dilation and curettage (D&C), to remove the abnormal tissue, followed by regular hCG monitoring to ensure complete resolution and to detect any potential malignant transformation early.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between complete and partial moles
  • Understanding the implications of hCG monitoring
  • Recognizing the risk of choriocarcinoma
  • Interpreting ultrasound findings accurately

Audit Risk Factors

  • Inaccurate documentation of hCG levels
  • Failure to note the presence of fetal tissue
  • Misclassification of complete vs. partial moles
  • Inadequate follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of symptoms, ultrasound findings, and hCG levels is essential for accurate coding.

Common Clinical Scenarios

Patients presenting with abnormal bleeding in early pregnancy, requiring ultrasound evaluation.

Billing Considerations

Coders must ensure that all relevant clinical details are captured to support the diagnosis and treatment plan.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal and fetal health, including any complications arising from the mole.

Common Clinical Scenarios

Management of high-risk pregnancies where molar pregnancies are suspected or diagnosed.

Billing Considerations

High-risk factors must be documented to justify the complexity of care and coding.

Coding Guidelines

Inclusion Criteria

Use O01.1 When
  • According to the official ICD
  • 10 coding guidelines, accurate coding for O01
  • 1 requires documentation of the type of hydatidiform mole, associated symptoms, and any treatments performed
  • Coders should ensure that all relevant clinical information is included to support the diagnosis

Exclusion Criteria

Do NOT use O01.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

58120CPT Code

Dilation and curettage, diagnostic and/or therapeutic

Clinical Scenario

Used for the surgical management of incomplete hydatidiform moles.

Documentation Requirements

Document indication for D&C, findings, and post-operative care.

Specialty Considerations

Obstetricians should ensure that the procedure is well-documented to support the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hydatidiform moles, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better patient management and research outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hydatidiform moles, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better patient management and research outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of hydatidiform moles, improving the accuracy of diagnosis and treatment tracking. This specificity aids in better patient management and research outcomes.

Resources

Clinical References

  • •
    Gestational Trophoblastic Disease: A Guide for Patients

Coding & Billing References

  • •
    Gestational Trophoblastic Disease: A Guide for Patients

Frequently Asked Questions

What is the significance of hCG monitoring in incomplete hydatidiform moles?

hCG monitoring is crucial in incomplete hydatidiform moles to ensure that the abnormal tissue is completely removed and to detect any potential malignant transformation into choriocarcinoma. Regular monitoring helps in timely intervention if hCG levels do not decline as expected.