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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.00

O35.00

Billable

Maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O35.00 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, unspecified.

Key Diagnostic Point:

O35.00 is used to indicate maternal care for a fetus suspected of having a central nervous system malformation or damage. This code is applicable when there is a clinical suspicion based on prenatal imaging or maternal history, but no definitive diagnosis has been established. Central nervous system malformations can include conditions such as spina bifida, anencephaly, or other neural tube defects. Maternal care may involve additional monitoring, genetic counseling, and planning for delivery in a specialized facility if necessary. The management of such cases often requires a multidisciplinary approach, including obstetricians, maternal-fetal medicine specialists, and pediatric neurologists, to ensure optimal outcomes for both the mother and the fetus. Prenatal diagnosis may involve advanced imaging techniques such as ultrasound or MRI, and genetic testing may be recommended to assess the risk of hereditary conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate interpretation of prenatal imaging results
  • Potential for multiple differential diagnoses
  • Requirement for interdisciplinary communication and documentation
  • Variability in clinical presentation and management protocols

Audit Risk Factors

  • Inadequate documentation of prenatal imaging findings
  • Failure to document maternal counseling and education
  • Lack of clarity in the suspected diagnosis
  • Inconsistent coding of related conditions

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of prenatal visits, imaging results, and maternal counseling sessions are essential for accurate coding.

Common Clinical Scenarios

A patient presents with abnormal ultrasound findings suggesting a potential CNS malformation, requiring further evaluation and monitoring.

Billing Considerations

Ensure that all relevant imaging and genetic counseling notes are included in the medical record to support the diagnosis.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, including maternal history and detailed ultrasound findings.

Common Clinical Scenarios

A high-risk pregnancy where the mother has a family history of neural tube defects, necessitating close monitoring and potential intervention.

Billing Considerations

Consideration of referral to genetic specialists for counseling and testing may be necessary.

Coding Guidelines

Inclusion Criteria

Use O35.00 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when there is a clinical suspicion of CNS malformation without a definitive diagnosis
  • Documentation must support the need for this code

Exclusion Criteria

Do NOT use O35.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

Ultrasound, fetal, transabdominal, real-time with image documentation

Clinical Scenario

Used to evaluate suspected CNS malformations during pregnancy.

Documentation Requirements

Document the indication for the ultrasound and findings related to CNS assessment.

Specialty Considerations

Ensure that the ultrasound report is detailed and correlates with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the ability to track and manage cases of suspected CNS malformations effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the ability to track and manage cases of suspected CNS malformations effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the ability to track and manage cases of suspected CNS malformations effectively.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What should be documented to support the use of O35.00?

Documentation should include details of the prenatal imaging findings, any clinical suspicion of CNS malformation, maternal history, and any referrals for further evaluation or genetic counseling.