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ICD-10 Guide
ICD-10 CodesChapter 15: Pregnancy, childbirth and the puerperiumO35

O35

Non-billable

Maternal care for known or suspected fetal abnormality and damage

Chapter 15:Pregnancy, childbirth and the puerperium

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 O35 is a used to indicate a diagnosis of maternal care for known or suspected fetal abnormality and damage.

Key Diagnostic Point:

ICD-10 Category O35 pertains to maternal care for known or suspected fetal abnormalities and damage. This category encompasses a range of conditions where a fetal abnormality is identified or suspected during pregnancy, including congenital malformations, genetic disorders, and other anomalies that may affect the fetus's health and development. The clinical significance of this category lies in the need for careful monitoring and management of pregnancies complicated by these conditions to optimize outcomes for both the mother and the fetus. Healthcare providers must be vigilant in assessing risks and providing appropriate interventions, which may include specialized imaging, genetic counseling, and multidisciplinary care approaches.

  • The usage of O35 codes is critical in ensuring that healthcare providers can accurately document and communicate the complexities of managing pregnancies with fetal abnormalities. These codes help facilitate proper care planning and resource allocation, as well as assist in research and quality improvement initiatives. Accurate coding is essential for appropriate reimbursement and to ensure that patients receive the necessary care and support throughout their pregnancy journey. Providers should be aware of the nuances in coding within this category to ensure compliance and optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions covered
  • Need for detailed clinical documentation
  • Potential for complications requiring multidisciplinary care

Audit Risk Factors

  • Inadequate documentation of fetal conditions
  • Misuse of codes leading to claim denials
  • Failure to update codes based on evolving clinical information

Specialty Focus

Medical Specialties

Obstetrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Maternal-Fetal Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the O35 category is significant, as it directly influences the management of pregnancies complicated by fetal abnormalities. Accurate coding and documentation can lead to improved care coordination and better health outcomes for both mothers and their babies. Additionally, this category plays a role in population health initiatives by allowing for the tracking of fetal abnormalities and associated maternal health trends. Understanding the prevalence and outcomes of these conditions can inform public health strategies and resource allocation.
Administratively, the O35 category affects healthcare systems by influencing reimbursement rates and funding for maternal-fetal medicine services. As healthcare trends evolve, the emphasis on quality measures and patient-centered care continues to grow, making it essential for providers to accurately capture the complexities of maternal care for fetal abnormalities. This not only supports individual patient care but also contributes to broader healthcare quality improvement efforts.

ICD-9 vs ICD-10

The clinical impact of the O35 category is significant, as it directly influences the management of pregnancies complicated by fetal abnormalities. Accurate coding and documentation can lead to improved care coordination and better health outcomes for both mothers and their babies. Additionally, this category plays a role in population health initiatives by allowing for the tracking of fetal abnormalities and associated maternal health trends. Understanding the prevalence and outcomes of these conditions can inform public health strategies and resource allocation. Administratively, the O35 category affects healthcare systems by influencing reimbursement rates and funding for maternal-fetal medicine services. As healthcare trends evolve, the emphasis on quality measures and patient-centered care continues to grow, making it essential for providers to accurately capture the complexities of maternal care for fetal abnormalities. This not only supports individual patient care but also contributes to broader healthcare quality improvement efforts.

Reimbursement & Billing Impact

reimbursement rates and funding for maternal-fetal medicine services. As healthcare trends evolve, the emphasis on quality measures and patient-centered care continues to grow, making it essential for providers to accurately capture the complexities of maternal care for fetal abnormalities. This not only supports individual patient care but also contributes to broader healthcare quality improvement efforts.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for O35

Coding & Billing References

  • •
    Official ICD-10 Guidelines for O35

Frequently Asked Questions

What conditions are included in O35?

O35 includes conditions such as congenital malformations, chromosomal abnormalities, and other fetal anomalies that are known or suspected during pregnancy.

When should I use O35 codes?

O35 codes should be used when there is a known or suspected fetal abnormality that requires special maternal care and monitoring throughout the pregnancy.

What documentation is required for O35?

Documentation must include detailed clinical findings, diagnostic imaging results, and any referrals to specialists, as well as ongoing assessments of the fetal condition.