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v1.0.0
ICD-10 Guide
ICD-10 CodesO26.2

O26.2

Billable

Pregnancy care for patient with recurrent pregnancy loss

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

Code Description

ICD-10 O26.2 is a billable code used to indicate a diagnosis of pregnancy care for patient with recurrent pregnancy loss.

Key Diagnostic Point:

Recurrent pregnancy loss (RPL) is defined as the occurrence of two or more consecutive pregnancy losses before 20 weeks of gestation. This condition poses significant emotional and physical challenges for patients and requires comprehensive obstetric care. Management of RPL often involves a multidisciplinary approach, particularly when complicated by underlying maternal conditions such as renal, cardiac, or respiratory issues. Patients with renal complications may experience altered renal function affecting fluid balance and medication metabolism, while those with cardiac conditions may face increased risks of maternal morbidity and mortality during pregnancy. Respiratory conditions can complicate oxygen delivery to the fetus, necessitating careful monitoring and management. Obstetric care for these patients includes thorough evaluation, genetic counseling, and potential interventions such as progesterone supplementation or immunotherapy, depending on the underlying cause of the recurrent losses. Close monitoring throughout the pregnancy is essential to ensure both maternal and fetal well-being.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Multiple underlying conditions that may contribute to recurrent pregnancy loss.
  • Need for interdisciplinary collaboration among specialists.
  • Variability in treatment protocols based on individual patient history.
  • Documentation of previous pregnancy losses and their management.

Audit Risk Factors

  • Inadequate documentation of previous pregnancy losses.
  • Failure to document coexisting maternal conditions.
  • Lack of clear treatment plans or follow-up care.
  • Misclassification of the type of pregnancy loss.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed history of previous pregnancies, including outcomes and any interventions.

Common Clinical Scenarios

Patients with a history of multiple miscarriages seeking care for a new pregnancy.

Billing Considerations

Consideration of psychological support and counseling for patients experiencing recurrent losses.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessment of maternal health, including cardiac, renal, and respiratory evaluations.

Common Clinical Scenarios

Management of high-risk pregnancies with underlying medical conditions.

Billing Considerations

Coordination of care among multiple specialists to address complex maternal health issues.

Coding Guidelines

Inclusion Criteria

Use O26.2 When
  • Follow the official ICD
  • CM guidelines for coding obstetric conditions, ensuring that all relevant details of the patient's history and current pregnancy status are documented
  • Specific criteria for recurrent pregnancy loss must be met, including the number of losses and any associated maternal conditions

Exclusion Criteria

Do NOT use O26.2 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.

Documentation Requirements

Complete documentation of all prenatal visits, delivery details, and postpartum follow-up.

Specialty Considerations

Obstetricians must ensure that all aspects of care are documented to support billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, enabling better tracking of patient outcomes and more tailored care plans. This specificity aids in research and quality improvement initiatives in obstetric care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, enabling better tracking of patient outcomes and more tailored care plans. This specificity aids in research and quality improvement initiatives in obstetric care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of recurrent pregnancy loss, enabling better tracking of patient outcomes and more tailored care plans. This specificity aids in research and quality improvement initiatives in obstetric care.

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 coding O26.2?

Documentation must include a detailed history of previous pregnancy losses, any underlying maternal health conditions, and the management plan for the current pregnancy. This ensures accurate coding and supports the complexity of care provided.