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ICD-10 Guide
ICD-10 CodesO35.19

O35.19

Billable

Maternal care for (suspected) chromosomal abnormality in fetus, other chromosomal abnormality

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

Code Description

ICD-10 O35.19 is a billable code used to indicate a diagnosis of maternal care for (suspected) chromosomal abnormality in fetus, other chromosomal abnormality.

Key Diagnostic Point:

O35.19 is used to indicate maternal care for a fetus suspected of having a chromosomal abnormality that is not specified elsewhere. This code encompasses a range of conditions that may arise during pregnancy, including but not limited to Down syndrome, Turner syndrome, and other genetic disorders. Prenatal diagnosis often involves advanced imaging techniques such as ultrasound and genetic testing, including amniocentesis or chorionic villus sampling (CVS). Maternal care may include counseling regarding the implications of these abnormalities, potential outcomes, and options available to the parents. It is crucial for healthcare providers to document the suspected abnormality, the methods used for diagnosis, and any follow-up care or referrals made to specialists, such as genetic counselors or maternal-fetal medicine specialists. Accurate coding is essential for appropriate reimbursement and to ensure that the healthcare team can provide comprehensive care tailored to the needs of the mother and fetus.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of chromosomal abnormalities that may be suspected or diagnosed.
  • Need for detailed documentation of diagnostic procedures and results.
  • Potential for multiple consultations and referrals to specialists.
  • Variability in clinical presentation and management strategies.

Audit Risk Factors

  • Inadequate documentation of the suspected chromosomal abnormality.
  • Failure to document the results of genetic testing.
  • Lack of evidence for referrals to specialists.
  • Insufficient detail in prenatal counseling notes.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include details of the suspected abnormality, diagnostic tests performed, and any counseling provided.

Common Clinical Scenarios

A patient undergoing routine prenatal screening who is referred for further evaluation due to abnormal ultrasound findings.

Billing Considerations

Ensure that all genetic counseling sessions are documented, including patient understanding and decisions made.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors, diagnostic imaging, and genetic testing results is essential.

Common Clinical Scenarios

Management of a pregnancy complicated by a known chromosomal abnormality, requiring multidisciplinary care.

Billing Considerations

Consider the implications of findings on delivery planning and postpartum care.

Coding Guidelines

Inclusion Criteria

Use O35.19 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used in conjunction with appropriate documentation of the maternal care provided and the suspected fetal condition

Exclusion Criteria

Do NOT use O35.19 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

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

Clinical Scenario

Used during routine prenatal visits to assess fetal growth and development.

Documentation Requirements

Document the reason for the ultrasound, findings, and any follow-up actions.

Specialty Considerations

Obstetricians should ensure that all relevant findings are communicated to the patient.

88271CPT Code

Cytogenetic analysis, chromosome analysis, each specimen

Clinical Scenario

Performed when chromosomal abnormalities are suspected based on ultrasound findings.

Documentation Requirements

Document the indication for testing and results of the analysis.

Specialty Considerations

Genetic counselors should be involved in the interpretation of results.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal care for suspected chromosomal abnormalities, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal care for suspected chromosomal abnormalities, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 when using code O35.19?

Documentation should include the suspected chromosomal abnormality, results of any genetic testing, details of counseling provided, and any referrals made to specialists.