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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.07

O35.07

Billable

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

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

Code Description

ICD-10 O35.07 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, microcephaly.

Key Diagnostic Point:

O35.07 is used to indicate maternal care for a fetus suspected of having a central nervous system malformation or damage, specifically microcephaly. Microcephaly is characterized by an abnormally small head size, which can be indicative of underlying neurological issues. This condition may arise from genetic factors, environmental influences, or infections during pregnancy. Maternal care involves comprehensive prenatal assessments, including ultrasounds and genetic counseling, to evaluate the fetus's development and identify any abnormalities. The management of such cases requires a multidisciplinary approach, often involving obstetricians, maternal-fetal medicine specialists, and genetic counselors to provide appropriate care and support to the mother and fetus. Early diagnosis and intervention are crucial for optimizing outcomes and preparing for potential complications during delivery and postpartum care.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal diagnostic testing and interpretation
  • Involvement of multiple specialties in care management
  • Variability in clinical presentation and severity of conditions
  • Documentation of maternal and fetal health history

Audit Risk Factors

  • Inadequate documentation of diagnostic tests performed
  • Failure to document maternal counseling and education
  • Misclassification of fetal conditions
  • Lack of follow-up care documentation

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed maternal and fetal health records, including ultrasound findings and genetic testing results.

Common Clinical Scenarios

Prenatal visits where microcephaly is suspected based on ultrasound measurements or family history.

Billing Considerations

Ensure all relevant maternal health factors are documented, including any risk factors that may contribute to fetal abnormalities.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of high-risk assessments, including detailed ultrasound reports and genetic counseling notes.

Common Clinical Scenarios

Management of pregnancies with known genetic disorders or significant ultrasound findings indicating potential CNS malformations.

Billing Considerations

Focus on the interdisciplinary approach to care, ensuring all specialists involved are documented.

Coding Guidelines

Inclusion Criteria

Use O35.07 When
  • Follow the official ICD
  • CM guidelines for coding maternal care, ensuring that all relevant clinical information is documented and that the code reflects the most specific diagnosis available

Exclusion Criteria

Do NOT use O35.07 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

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

Clinical Scenario

Used during routine prenatal visits to assess fetal growth and detect abnormalities.

Documentation Requirements

Document the findings of the ultrasound, including measurements and any abnormalities noted.

Specialty Considerations

Obstetricians should ensure that all relevant clinical information is included in the report.

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 accuracy of diagnoses and facilitating better care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the accuracy of diagnoses and facilitating better care management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the accuracy of diagnoses and facilitating better care management.

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 O35.07?

Documentation should include ultrasound findings, maternal health history, any genetic counseling provided, and follow-up assessments to confirm the diagnosis of microcephaly.