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O26.641 vs O48

O26.641 (Intrahepatic cholestasis of pregnancy, first trimester) compared with O48 (Late pregnancy), from the official CMS tabular data.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Summary

These codes can be reported together when both conditions are documented, because O26.641 lists O48 under Excludes2, which marks them as distinct conditions.

Official rule
What is different?

The conditions named and billing status.O26.641 is “Intrahepatic cholestasis of pregnancy, first trimester”; O48 is “Late pregnancy”. O48 is a non-billable header; O26.641 is billable.

Registry fact

Can these codes be reported together?

Yes, when both are documented.O26.641 lists O48 under Excludes2: “maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code.

Official rule

Is there an Excludes2 relationship?

Yes.O26.641’s tabular entry: “maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)”. The note covers O48.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.O48 is a non-billable header, but O26.641 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Excludes2 relationship

O26.641
Intrahepatic cholestasis of pregnancy, first trimester
↔
O48
Late pregnancy

What we found

Yes, when both are documented.O26.641 carries an Excludes2 note covering O48: “maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.

Official descriptionDiffers
O26.641

Intrahepatic cholestasis of pregnancy, first trimester

O48

Late pregnancy

StatusDiffers
O26.641
Billable
O48
Non-billable header

A header is not reported on a claim; a code beneath it is.

Report instead: O48.0, O48.1

Excludes2Differs
O26.641
  • hepatorenal syndrome following labor and delivery (O90.41)
  • maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)
  • maternal diseases classifiable elsewhere but complicating pregnancy, labor and delivery, and the puerperium (O98-O99)
O48

None at this code

Use additional codeDiffers
O26.641
  • code for hepatic obstruction (K76.89)
  • code to identify the specific disorder
O48

None at this code

CategoryDiffers
O26.641

O26 Maternal care for other conditions predominantly related to pregnancy

O48

Is itself a category

ChapterSame for both

O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A)

No Excludes1, Code first, Code also, Includes and 7th character note at either code.

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, notes every code shares are dimmed.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources