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ICD-10 Guide
ICD-10 CodesO26.01

O26.01

Billable

Excessive weight gain in pregnancy, first trimester

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

Code Description

ICD-10 O26.01 is a billable code used to indicate a diagnosis of excessive weight gain in pregnancy, first trimester.

Key Diagnostic Point:

Excessive weight gain in pregnancy during the first trimester is a condition where a pregnant woman gains more weight than is considered healthy for her pre-pregnancy body mass index (BMI). This condition can lead to various complications, including gestational diabetes, hypertension, and increased risk of cesarean delivery. It is essential for healthcare providers to monitor weight gain closely, especially in the first trimester, as this is a critical period for fetal development. Factors contributing to excessive weight gain may include pre-existing obesity, dietary habits, and lack of physical activity. Maternal care should focus on nutritional counseling, lifestyle modifications, and regular monitoring to mitigate risks associated with excessive weight gain. Additionally, conditions such as renal, cardiac, and respiratory issues can complicate pregnancy and may necessitate a multidisciplinary approach to care, ensuring that both maternal and fetal health are prioritized.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in pre-pregnancy BMI and its impact on weight gain recommendations.
  • Need for comprehensive documentation of weight gain patterns and associated risks.
  • Potential overlap with other conditions such as gestational diabetes or hypertension.
  • Variability in clinical guidelines regarding acceptable weight gain during pregnancy.

Audit Risk Factors

  • Inadequate documentation of pre-pregnancy weight and BMI.
  • Failure to document counseling provided regarding weight management.
  • Misclassification of excessive weight gain as normal weight gain.
  • Lack of follow-up documentation on weight monitoring.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include pre-pregnancy weight, BMI, weight gain at each visit, and any counseling provided.

Common Clinical Scenarios

A patient with a history of obesity presenting for her first prenatal visit, requiring weight management strategies.

Billing Considerations

Consideration of comorbidities such as hypertension or diabetes that may be exacerbated by excessive weight gain.

Maternal-Fetal Medicine

Documentation Requirements

Detailed documentation of maternal and fetal assessments, including any complications arising from excessive weight gain.

Common Clinical Scenarios

A high-risk pregnancy where excessive weight gain is noted, necessitating a referral to a maternal-fetal specialist.

Billing Considerations

Focus on the impact of excessive weight gain on fetal development and maternal health, requiring close monitoring.

Coding Guidelines

Inclusion Criteria

Use O26.01 When
  • According to the official ICD
  • 10 coding guidelines, O26
  • 01 should be used when excessive weight gain is documented during the first trimester
  • Coders must ensure that the weight gain is clearly documented and that it exceeds the recommended guidelines based on the patient's pre
  • pregnancy BMI

Exclusion Criteria

Do NOT use O26.01 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 prenatal visits where weight gain is monitored.

Documentation Requirements

Documentation of weight, BMI, and counseling provided.

Specialty Considerations

Obstetricians should ensure that all relevant weight management discussions are documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions such as excessive weight gain in pregnancy, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions such as excessive weight gain in pregnancy, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What constitutes excessive weight gain in pregnancy?

Excessive weight gain is defined as gaining more than the recommended amount based on pre-pregnancy BMI. For example, women with a normal BMI should gain between 25-35 pounds during pregnancy, while those with a BMI of 30 or higher should gain less.