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ICD-10 Guide
ICD-10 CodesO35.12

O35.12

Billable

Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 18

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

Code Description

ICD-10 O35.12 is a billable code used to indicate a diagnosis of maternal care for (suspected) chromosomal abnormality in fetus, trisomy 18.

Key Diagnostic Point:

O35.12 refers to maternal care provided for suspected chromosomal abnormalities in the fetus, specifically Trisomy 18, also known as Edwards syndrome. This condition is characterized by the presence of an extra 18th chromosome, leading to severe developmental and physical abnormalities. Maternal care for this condition typically involves comprehensive prenatal screening and diagnostic testing, including non-invasive prenatal testing (NIPT), chorionic villus sampling (CVS), or amniocentesis. These tests help confirm the diagnosis and assess the severity of the condition. Counseling is a critical component of care, as families must be informed about the implications of the diagnosis, potential outcomes, and options available, including the possibility of termination of pregnancy. Regular monitoring through ultrasounds and maternal-fetal medicine consultations is essential to manage the pregnancy effectively and prepare for any complications that may arise during delivery or postpartum. The emotional and psychological support for the mother and family is also a vital aspect of care, given the high-risk nature of pregnancies complicated by chromosomal abnormalities.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate diagnosis through advanced genetic testing
  • Involvement of multidisciplinary teams for care management
  • Counseling requirements for families regarding prognosis and options
  • Documentation of maternal and fetal monitoring throughout pregnancy

Audit Risk Factors

  • Inadequate documentation of genetic counseling sessions
  • Failure to document the results of diagnostic tests
  • Lack of detailed notes on maternal-fetal monitoring
  • Improper linkage of diagnosis to procedures performed

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of prenatal visits, including results of screenings and tests, counseling notes, and maternal health assessments.

Common Clinical Scenarios

Routine prenatal visits with additional focus on genetic counseling and monitoring for complications associated with Trisomy 18.

Billing Considerations

Ensure all documentation reflects the complexity of care and includes psychosocial support provided to the patient.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, genetic testing results, and management plans tailored to the specific needs of the patient.

Common Clinical Scenarios

Management of pregnancies complicated by Trisomy 18, including high-resolution ultrasounds and consultations regarding delivery planning.

Billing Considerations

Focus on the integration of genetic counseling and maternal health assessments in the care plan.

Coding Guidelines

Inclusion Criteria

Use O35.12 When
  • Follow the official ICD
  • CM guidelines for coding obstetric conditions, ensuring that all documentation supports the diagnosis and reflects the complexity of care provided
  • Specific criteria for coding suspected chromosomal abnormalities must be met, including the necessity of genetic testing

Exclusion Criteria

Do NOT use O35.12 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76817CPT Code

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

Clinical Scenario

Used for monitoring fetal development in pregnancies with suspected chromosomal abnormalities.

Documentation Requirements

Detailed ultrasound reports must include findings related to fetal growth and any abnormalities noted.

Specialty Considerations

Obstetricians should ensure that all findings are documented to support the diagnosis and any subsequent coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of chromosomal abnormalities, improving the accuracy of data collection and reimbursement processes. O35.12 provides a clear framework for documenting maternal care for suspected fetal abnormalities.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of chromosomal abnormalities, improving the accuracy of data collection and reimbursement processes. O35.12 provides a clear framework for documenting maternal care for suspected fetal abnormalities.

Reimbursement & Billing Impact

reimbursement processes. O35.12 provides a clear framework for documenting maternal care for suspected fetal abnormalities.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What is the significance of coding O35.12?

Coding O35.12 is significant as it reflects the complexity of managing pregnancies affected by chromosomal abnormalities. Accurate coding ensures appropriate care management and reimbursement while highlighting the need for specialized support for affected families.