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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.06

O35.06

Billable

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

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

Code Description

ICD-10 O35.06 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, hydrocephaly.

Key Diagnostic Point:

O35.06 is used to indicate maternal care for a fetus suspected of having a central nervous system malformation or damage, specifically hydrocephaly. Hydrocephaly is characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure and potential brain damage. This condition can arise from various etiologies, including congenital malformations, infections during pregnancy (such as Zika virus), or genetic syndromes. Prenatal diagnosis often involves advanced imaging techniques such as ultrasound or MRI to assess fetal brain structure and fluid levels. Maternal care may include genetic counseling, monitoring of fetal development, and planning for delivery in a specialized setting if necessary. The management of hydrocephaly may also involve a multidisciplinary approach, including pediatric neurology and neurosurgery post-delivery.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal diagnostic imaging interpretation
  • Involvement of multiple specialties in care management
  • Potential for associated genetic conditions requiring additional coding
  • Variability in clinical presentation and severity of hydrocephaly

Audit Risk Factors

  • Inadequate documentation of prenatal imaging results
  • Failure to document maternal counseling and education
  • Misclassification of the severity of fetal condition
  • Lack of clear linkage between diagnosis and maternal care provided

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

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

Common Clinical Scenarios

Routine prenatal visits where hydrocephaly is suspected based on ultrasound findings, or referrals to specialists for further evaluation.

Billing Considerations

Ensure that all maternal risk factors and interventions are documented to support the diagnosis and care plan.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, genetic counseling sessions, and multidisciplinary care plans.

Common Clinical Scenarios

Management of pregnancies with known fetal anomalies, including hydrocephaly, requiring specialized monitoring and intervention.

Billing Considerations

Coordination of care among specialists and clear documentation of all findings and recommendations are critical.

Coding Guidelines

Inclusion Criteria

Use O35.06 When
  • Follow the official ICD
  • CM guidelines for coding maternal care and fetal conditions, ensuring that all documentation supports the diagnosis and care provided

Exclusion Criteria

Do NOT use O35.06 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

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

Clinical Scenario

Used for initial assessment of fetal anatomy and potential abnormalities.

Documentation Requirements

Document findings, gestational age, and any follow-up recommendations.

Specialty Considerations

Obstetricians should ensure that all imaging studies are clearly linked to 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 fetal conditions, improving the accuracy of maternal care documentation and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fetal conditions, improving the accuracy of maternal care documentation and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 is the significance of coding O35.06?

Coding O35.06 is crucial for accurately documenting maternal care for suspected fetal CNS malformations, ensuring appropriate management and follow-up for both mother and child.