ICD-10 Coding for Recurrent Pregnancy Loss(O26.21, O26.22, D68.69)
Complete ICD-10-CM coding and documentation guide for Recurrent Pregnancy Loss. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Recurrent Pregnancy Loss
O26.2Primary Range
Pregnancy care for recurrent pregnancy loss
Primary range for managing patients with recurrent pregnancy loss during pregnancy.
Encounter for genetic testing for procreative management
Used for genetic testing related to recurrent pregnancy loss.
Other thrombophilia
Used when thrombophilia is identified as a cause of recurrent pregnancy loss.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| O26.21 | Pregnancy care for recurrent pregnancy loss, first trimester | Use for patients with recurrent pregnancy loss in the first trimester. |
|
| O26.22 | Pregnancy care for recurrent pregnancy loss, second trimester | Use for patients with recurrent pregnancy loss in the second trimester. |
|
| D68.69 | Other thrombophilia | Use when thrombophilia is identified as a contributing factor to RPL. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for recurrent pregnancy loss
Essential facts and insights about Recurrent Pregnancy Loss
Primary ICD-10-CM Codes for recurrent pregnancy loss
Decision Criteria
clinical Criteria
- Two or more consecutive first-trimester losses
Applicable To
- Two or more consecutive losses before 13 weeks 6 days
Excludes
- Spontaneous abortion without recurrent history
Clinical Validation Requirements
- Documented history of two or more consecutive first-trimester losses
- Gestational age of each loss
Code-Specific Risks
- Incorrectly coding without specifying trimester
Coding Notes
- Ensure documentation includes the number and gestational age of losses.
O26.22 - Pregnancy care for recurrent pregnancy loss, second trimester
Use for patients with recurrent pregnancy loss in the second trimester.
Applicable To
- Two or more consecutive losses between 14 weeks 0 days and 19 weeks 6 days
Excludes
- Spontaneous abortion without recurrent history
Clinical Validation Requirements
- Documented history of two or more consecutive second-trimester losses
- Gestational age of each loss
Coding Notes
Ensure documentation includes the number and gestational age of losses.
D68.69 - Other thrombophilia
Use when thrombophilia is identified as a contributing factor to RPL.
Applicable To
- Thrombophilia confirmed by laboratory testing
Excludes
- Thrombophilia not confirmed by laboratory testing
Clinical Validation Requirements
- Laboratory confirmation of thrombophilia (e.g., positive lupus anticoagulant)
Coding Notes
Ensure lab results are documented to support the use of this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for genetic testing for procreative management
Z31.83Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Recurrent Pregnancy Loss to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code O26.21.
Impact
Clinical: Inaccurate clinical records., Regulatory: Potential for audit issues., Financial: Claims may be denied or delayed.
Mitigation Strategy
Always verify the trimester before coding., Use specific trimester codes (O26.21, O26.22).
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use O26.2 for prenatal visits focused on RPL management.
Impact
Using a general code without specifying the trimester.
Mitigation Strategy
Ensure documentation includes trimester-specific details.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Recurrent Pregnancy Loss, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Recurrent Pregnancy Loss
Use these documentation templates to ensure complete and accurate documentation for Recurrent Pregnancy Loss. These templates include all required elements for proper coding and billing.
Recurrent Pregnancy Loss Evaluation
Specialty: Obstetrics and GynecologyRequired Elements
- Patient history of pregnancy losses
- Gestational age of each loss
- Results of any genetic or thrombophilia testing
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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