2025 ICD-10-CM code O26
(Active) Effective Date: N/A Revision Date: N/A Maternal - Other maternal disorders predominantly related to pregnancy Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Maternal care for other conditions predominantly related to pregnancy.
Medical necessity is established by the need for specialized assessment and management of a maternal health issue whose severity or treatment options are affected by the patient's pregnancy.This necessitates medical intervention beyond routine prenatal care.
The clinical responsibility includes comprehensive assessment of the pregnant patient's condition, considering the influence of pregnancy,appropriate diagnostic testing, development of a treatment plan addressing both the pregnancy-related and unrelated aspects of the patient's health, monitoring of the patient's progress, and collaboration with other specialists as needed.
- Pregnancy, childbirth and the puerperium (O00-O9A)
- O20-O29 (Other maternal disorders predominantly related to pregnancy)
In simple words: This code is used when a pregnant woman sees a doctor for a health problem that's made worse by her pregnancy or needs special care because she's pregnant.
This ICD-10-CM code encompasses maternal care and management of various health conditions primarily associated with or exacerbated during pregnancy.It's used when a pregnant woman requires medical attention for conditions not specifically categorized elsewhere within Chapter 15 (O00-O9A), but are still significantly influenced by her pregnancy.The code is applied when the condition's severity or management is directly impacted by the pregnancy state.
Example 1: A 30-year-old pregnant woman at 28 weeks gestation presents with severe migraine headaches, unresponsive to standard over-the-counter pain relievers.Her pregnancy status necessitates careful medication selection to avoid harm to the fetus.Code O26 would be used to reflect the maternal care required for this condition complicated by pregnancy., A 25-year-old pregnant woman at 12 weeks gestation is experiencing severe back pain due to scoliosis, which has worsened during pregnancy. The increased strain on her spine demands a specialized management approach., A 35-year-old pregnant patient at 36 weeks gestation presents with a flare-up of her Crohn's disease. Her pregnancy necessitates modifications to her usual treatment regimen. Code O26 is appropriate as her existing condition is influenced by the pregnancy.
Detailed medical history, including pre-pregnancy health status, current symptoms, relevant physical examination findings, results of any diagnostic tests (lab results, imaging studies),treatment plan (including medication, therapy), and progress notes.
** This code should be used judiciously and only when no other more specific code within Chapter 15 applies.Always ensure proper documentation supports the medical necessity of the care rendered.
- Payment Status: Active
- Specialties:Obstetrics, Gynecology, Family Medicine
- Place of Service:Office, Hospital, Clinic