Version 2024

2024 ICD-10-CM Diagnosis Code O26.40

Herpes gestationis, unspecified trimester

ICD-10-CM Code:: O26.40
ICD-10 Code for:: Herpes gestationis, unspecified trimester
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
Code Navigator:

Code Information
Approximate Synonyms
Clinical Classification
Tabular List of Diseases and Injuries
Code Edits
Diagnostic Related Groups Mapping
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Pregnancy, childbirth and the puerperium
(O00-O9A)
- Other maternal disorders predominantly related to pregnancy
  (O20-O29)
  - Maternal care for other conditions predominantly related to pregnancy
    (O26)

O26.40 is a billable diagnosis code used to specify a medical diagnosis of herpes gestationis, unspecified trimester. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

The code O26.40 is applicable to female patients aged 12 through 55 years inclusive. It is clinically and virtually impossible to use this code on a non-female patient outside the stated age range.

The code is commonly used in ob/gyn medical specialties to specify clinical concepts such as maternal disorders related to pregnancy.

Unspecified diagnosis codes like O26.40 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Herpes gestationis

Clinical Classification

Clinical Category	CCSR Category Code	Inpatient Default CCSR	Outpatient Default CCSR
Other specified complications in pregnancy	PRG028	Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.	Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
Viral infection	INF008	N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis.	N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

Maternity diagnoses - The Medicare Code Editor detects inconsistencies in maternity cases by checking a patient's age and any diagnosis on the patient's record. The maternity code edits apply to patients age ange is 9–64 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).
Diagnoses for females only - The Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, these edits apply to FEMALES only .

O26.40 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
817	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC	14	2.255
818	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC	14	1.1731
819	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC	14	0.9072

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert O26.40 to ICD-9-CM

ICD-9-CM Code: 646.80 - Preg compl NEC-unspec
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Pemphigus

Pemphigus is an autoimmune disorder. If you have it, your immune system attacks healthy cells in your skin and mouth, causing blisters and sores. No one knows the cause. Pemphigus does not spread from person to person. It does not appear to be inherited. But some people's genes put them more at risk for pemphigus.

Pemphigoid is also an autoimmune skin disease. It leads to deep blisters that do not break easily. Pemphigoid is most common in older adults and may be fatal for older, sick patients.

Doctors diagnose pemphigus with a physical exam, a biopsy, and blood tests. The treatment of pemphigus and pemphigoid is the same: one or more medicines to control symptoms. These may include:

Steroids, which reduce inflammation
Drugs that suppress the immune system response
Antibiotics to treat associated infections

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

[Learn More in MedlinePlus]

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

O26 Maternal care for other conditions predominantly related to pregnancy.
O26.0 Excessive weight gain in pregnancy.
O26.00 Excessive weight gain in pregnancy, unspecified trimester.
O26.01 Excessive weight gain in pregnancy, first trimester.
O26.02 Excessive weight gain in pregnancy, second trimester.
O26.03 Excessive weight gain in pregnancy, third trimester.
O26.1 Low weight gain in pregnancy.
O26.10 Low weight gain in pregnancy, unspecified trimester.
O26.11 Low weight gain in pregnancy, first trimester.
O26.12 Low weight gain in pregnancy, second trimester.
O26.13 Low weight gain in pregnancy, third trimester.
O26.2 Pregnancy care for patient with recurrent pregnancy loss.
O26.20 Pregnancy care for patient with recurrent pregnancy loss, unspecified trimester.
O26.21 Pregnancy care for patient with recurrent pregnancy loss, first trimester.
O26.22 Pregnancy care for patient with recurrent pregnancy loss, second trimester.
O26.23 Pregnancy care for patient with recurrent pregnancy loss, third trimester.
O26.3 Retained intrauterine contraceptive device in pregnancy.
O26.30 Retained intrauterine contraceptive device in pregnancy, unspecified trimester.
O26.31 Retained intrauterine contraceptive device in pregnancy, first trimester.
O26.32 Retained intrauterine contraceptive device in pregnancy, second trimester.
O26.33 Retained intrauterine contraceptive device in pregnancy, third trimester.
O26.4 Herpes gestationis.
O26.41 Herpes gestationis, first trimester.
O26.42 Herpes gestationis, second trimester.
O26.43 Herpes gestationis, third trimester.
O26.5 Maternal hypotension syndrome.
O26.50 Maternal hypotension syndrome, unspecified trimester.
O26.51 Maternal hypotension syndrome, first trimester.
O26.52 Maternal hypotension syndrome, second trimester.
O26.53 Maternal hypotension syndrome, third trimester.
O26.6 Liver and biliary tract disorders in pregnancy, childbirth and the puerperium.
O26.61 Liver and biliary tract disorders in pregnancy.
O26.611 Liver and biliary tract disorders in pregnancy, first trimester.
O26.612 Liver and biliary tract disorders in pregnancy, second trimester.
O26.613 Liver and biliary tract disorders in pregnancy, third trimester.
O26.619 Liver and biliary tract disorders in pregnancy, unspecified trimester.
O26.62 Liver and biliary tract disorders in childbirth.
O26.63 Liver and biliary tract disorders in the puerperium.
O26.64 Intrahepatic cholestasis of pregnancy.
O26.641 Intrahepatic cholestasis of pregnancy, first trimester.
O26.642 Intrahepatic cholestasis of pregnancy, second trimester.
O26.643 Intrahepatic cholestasis of pregnancy, third trimester.
O26.649 Intrahepatic cholestasis of pregnancy, unspecified trimester.
O26.7 Subluxation of symphysis (pubis) in pregnancy, childbirth and the puerperium.
O26.71 Subluxation of symphysis (pubis) in pregnancy.
O26.711 Subluxation of symphysis (pubis) in pregnancy, first trimester.
O26.712 Subluxation of symphysis (pubis) in pregnancy, second trimester.
O26.713 Subluxation of symphysis (pubis) in pregnancy, third trimester.
O26.719 Subluxation of symphysis (pubis) in pregnancy, unspecified trimester.
O26.72 Subluxation of symphysis (pubis) in childbirth.
O26.73 Subluxation of symphysis (pubis) in the puerperium.

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.