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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.09

O35.09

Billable

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

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

Code Description

ICD-10 O35.09 is a billable code used to indicate a diagnosis of maternal care for (suspected) other central nervous system malformation or damage in fetus.

Key Diagnostic Point:

O35.09 is used to indicate maternal care for a fetus suspected of having a central nervous system malformation or damage. This code encompasses a range of conditions that may affect the fetal brain and spinal cord, including but not limited to neural tube defects, congenital brain malformations, and other structural abnormalities. Prenatal diagnosis often involves advanced imaging techniques such as ultrasound and MRI, which can help identify these malformations early in pregnancy. Maternal care may include genetic counseling, additional monitoring, and planning for delivery in a specialized facility if necessary. The management of these cases requires a multidisciplinary approach, involving obstetricians, maternal-fetal medicine specialists, and pediatric neurologists to ensure optimal outcomes for both mother and child.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal diagnostic imaging interpretation
  • Involvement of multiple specialties in care management
  • Variability in fetal malformation presentations
  • Documentation of maternal counseling and decision-making processes

Audit Risk Factors

  • Inadequate documentation of diagnostic imaging results
  • Failure to document maternal counseling and informed consent
  • Misclassification of fetal abnormalities
  • Lack of follow-up documentation for suspected 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

Routine prenatal visits where fetal abnormalities are suspected based on ultrasound findings.

Billing Considerations

Ensure that all findings are clearly documented, including any referrals to specialists.

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 central nervous system anomalies requiring specialized care.

Billing Considerations

Focus on the integration of care among specialists and the documentation of all interventions.

Coding Guidelines

Inclusion Criteria

Use O35.09 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when there is a documented suspicion of a central nervous system malformation
  • Accurate documentation of the clinical findings and the rationale for the diagnosis is crucial

Exclusion Criteria

Do NOT use O35.09 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 during routine prenatal visits when fetal abnormalities are suspected.

Documentation Requirements

Document the reason for the ultrasound and findings.

Specialty Considerations

Obstetricians should ensure that imaging reports are included in the patient's medical record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of suspected conditions, improving the ability to track and manage maternal and fetal health outcomes. O35.09 provides a clear distinction between suspected and confirmed conditions, which is essential for appropriate care planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of suspected conditions, improving the ability to track and manage maternal and fetal health outcomes. O35.09 provides a clear distinction between suspected and confirmed conditions, which is essential for appropriate care planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of suspected conditions, improving the ability to track and manage maternal and fetal health outcomes. O35.09 provides a clear distinction between suspected and confirmed conditions, which is essential for appropriate care planning.

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

When should O35.09 be used?

O35.09 should be used when there is a documented suspicion of a central nervous system malformation in the fetus, based on clinical findings or imaging results, but not yet confirmed.