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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.3

O35.3

Billable

Maternal care for (suspected) damage to fetus from viral disease in mother

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

Code Description

ICD-10 O35.3 is a billable code used to indicate a diagnosis of maternal care for (suspected) damage to fetus from viral disease in mother.

Key Diagnostic Point:

O35.3 is used to indicate maternal care for a fetus that is suspected to be damaged due to a viral disease affecting the mother. This code encompasses a range of conditions where maternal viral infections, such as rubella, cytomegalovirus (CMV), or Zika virus, may lead to fetal abnormalities or genetic conditions. The maternal care involves close monitoring and prenatal diagnosis to assess the extent of potential fetal damage. This may include ultrasound examinations, amniocentesis, and other diagnostic tests to evaluate fetal health and development. The healthcare provider must document the maternal viral infection, any observed fetal abnormalities, and the management plan, which may involve referrals to maternal-fetal medicine specialists for high-risk pregnancies. Accurate coding is essential for proper reimbursement and to ensure that the healthcare team is aware of the potential risks to the fetus.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for comprehensive maternal history and documentation of viral infection.
  • Assessment of fetal abnormalities requires advanced diagnostic procedures.
  • Potential for multiple co-existing conditions complicating the coding.
  • Variability in clinical presentation of viral infections and their effects on the fetus.

Audit Risk Factors

  • Inadequate documentation of maternal viral infection.
  • Failure to document fetal abnormalities or diagnostic tests performed.
  • Misclassification of the severity of fetal damage.
  • Inconsistent coding of related conditions or co-morbidities.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed maternal history, including viral infection status, and any fetal assessments performed.

Common Clinical Scenarios

Pregnant women presenting with viral infections, such as rubella or Zika, and subsequent fetal monitoring.

Billing Considerations

Consideration of maternal vaccination history and its impact on fetal health.

Maternal-Fetal Medicine

Documentation Requirements

Extensive documentation of high-risk factors, including maternal viral infections and fetal assessments.

Common Clinical Scenarios

Management of pregnancies complicated by maternal infections and the need for specialized fetal monitoring.

Billing Considerations

Coordination of care with genetic counseling and pediatric specialists for potential outcomes.

Coding Guidelines

Inclusion Criteria

Use O35.3 When
  • According to ICD
  • 10 coding guidelines, O35
  • 3 should be used when there is a confirmed or suspected maternal viral infection impacting fetal health
  • Documentation must support the diagnosis, including maternal history, diagnostic tests, and any observed fetal abnormalities

Exclusion Criteria

Do NOT use O35.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76801CPT Code

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

Clinical Scenario

Used for monitoring fetal development in cases of suspected viral damage.

Documentation Requirements

Document the reason for ultrasound and findings related to fetal health.

Specialty Considerations

Obstetricians should ensure that ultrasound findings are clearly linked to maternal viral infections.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal conditions affecting fetal health, improving the accuracy of diagnosis and treatment planning. O35.3 provides a clear framework for documenting the impact of maternal viral diseases on fetal development.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions affecting fetal health, improving the accuracy of diagnosis and treatment planning. O35.3 provides a clear framework for documenting the impact of maternal viral diseases on fetal development.

Reimbursement & Billing Impact

reimbursement and to reflect the complexity of care provided.

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 documentation is required for coding O35.3?

Documentation must include the maternal viral infection diagnosis, any fetal abnormalities observed, and the management plan. Detailed notes on diagnostic tests and their results are also essential.