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ICD-10 Guide
ICD-10 CodesO26.13

O26.13

Billable

Low weight gain in pregnancy, third trimester

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

Code Description

ICD-10 O26.13 is a billable code used to indicate a diagnosis of low weight gain in pregnancy, third trimester.

Key Diagnostic Point:

Low weight gain during the third trimester of pregnancy can indicate potential complications for both the mother and the fetus. This condition may arise due to various factors, including inadequate caloric intake, underlying health issues such as renal, cardiac, or respiratory conditions, or psychosocial factors. In the third trimester, the fetus undergoes significant growth, and insufficient maternal weight gain can lead to intrauterine growth restriction (IUGR), preterm birth, or low birth weight. Maternal health conditions complicating pregnancy, such as chronic kidney disease, heart disease, or respiratory disorders, can further exacerbate the risk of low weight gain. It is crucial for healthcare providers to monitor weight gain closely, assess dietary intake, and evaluate any underlying medical conditions that may contribute to inadequate weight gain. Interventions may include nutritional counseling, dietary modifications, and close monitoring of both maternal and fetal health to ensure optimal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between normal and abnormal weight gain patterns.
  • Assessing the impact of coexisting maternal health conditions.
  • Understanding the implications of low weight gain on fetal development.
  • Navigating documentation requirements for high-risk pregnancies.

Audit Risk Factors

  • Inadequate documentation of maternal weight gain.
  • Failure to document underlying health conditions.
  • Lack of clear treatment plans or interventions.
  • Insufficient follow-up notes on maternal and fetal health.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal weight at each visit, dietary assessments, and any interventions provided.

Common Clinical Scenarios

A patient presenting with low weight gain due to hyperemesis gravidarum or a patient with a history of renal disease experiencing weight loss.

Billing Considerations

Ensure that all maternal health conditions are documented and that weight gain is assessed in the context of these conditions.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessments of maternal and fetal health, including ultrasound findings and growth assessments.

Common Clinical Scenarios

Management of a high-risk pregnancy with low weight gain due to cardiac complications.

Billing Considerations

Focus on the implications of low weight gain on fetal development and the need for specialized care.

Coding Guidelines

Inclusion Criteria

Use O26.13 When
  • Follow the official ICD
  • CM guidelines for coding obstetric conditions, ensuring that all relevant maternal and fetal health factors are documented
  • Weight gain should be assessed in the context of gestational age and any complicating conditions

Exclusion Criteria

Do NOT use O26.13 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 follow-up visits for monitoring weight gain and maternal health.

Documentation Requirements

Document weight measurements, dietary assessments, and any interventions.

Specialty Considerations

Ensure that the visit is clearly linked to the management of low weight gain.

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, enabling better tracking of maternal and fetal health outcomes. O26.13 provides a clear designation for low weight gain in the third trimester, facilitating targeted interventions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, enabling better tracking of maternal and fetal health outcomes. O26.13 provides a clear designation for low weight gain in the third trimester, facilitating targeted interventions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, enabling better tracking of maternal and fetal health outcomes. O26.13 provides a clear designation for low weight gain in the third trimester, facilitating targeted interventions.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What should be documented for low weight gain in pregnancy?

Documentation should include the patient's weight at each visit, dietary assessments, any underlying health conditions, and interventions provided to address low weight gain.