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v1.0.0
ICD-10 Guide
ICD-10 CodesO36.0

O36.0

Billable

Maternal care for rhesus isoimmunization

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

Code Description

ICD-10 O36.0 is a billable code used to indicate a diagnosis of maternal care for rhesus isoimmunization.

Key Diagnostic Point:

Maternal care for rhesus isoimmunization refers to the management and monitoring of pregnant women who are Rh-negative and have been sensitized to Rh-positive blood. This condition can lead to hemolytic disease of the fetus and newborn (HDFN), which can cause serious complications such as fetal anemia, hydrops fetalis, and intrauterine fetal demise. Care for these patients typically involves regular monitoring of fetal well-being through ultrasound assessments, Doppler studies to evaluate fetal blood flow, and possibly intrauterine transfusions if severe anemia is detected. Additionally, maternal care may include administration of Rh immunoglobulin (RhIg) to prevent further sensitization in future pregnancies. The management of rhesus isoimmunization is crucial to prevent adverse fetal outcomes, and it requires a multidisciplinary approach involving obstetricians, maternal-fetal medicine specialists, and pediatricians.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate identification of Rh status and sensitization history.
  • Complexity of monitoring fetal health and potential interventions.
  • Variability in clinical presentation and management protocols.
  • Documentation of multiple fetal assessments and interventions.

Audit Risk Factors

  • Inadequate documentation of maternal and fetal assessments.
  • Failure to document Rh status and sensitization history.
  • Lack of clarity on the rationale for interventions performed.
  • Inconsistent coding of related conditions or complications.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of maternal Rh status, fetal monitoring results, and any interventions performed.

Common Clinical Scenarios

Routine monitoring of an Rh-negative mother with a previously sensitized pregnancy, management of fetal anemia detected via ultrasound.

Billing Considerations

Ensure that all fetal assessments are documented, including ultrasound findings and any transfusions.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of high-risk assessments, including Doppler studies and intrauterine transfusion details.

Common Clinical Scenarios

Management of severe fetal anemia requiring transfusion, close monitoring of fetal growth and well-being.

Billing Considerations

Collaboration with neonatology for postnatal care planning.

Coding Guidelines

Inclusion Criteria

Use O36.0 When
  • Follow official ICD
  • CM guidelines for obstetric coding, ensuring that the code is used in conjunction with appropriate procedure codes for monitoring and interventions
  • Document all relevant clinical findings and management steps

Exclusion Criteria

Do NOT use O36.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76801CPT Code

Ultrasound, pregnant uterus, transabdominal

Clinical Scenario

Used for routine monitoring of fetal well-being in cases of rhesus isoimmunization.

Documentation Requirements

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

Specialty Considerations

Ensure that the ultrasound report includes details relevant to isoimmunization.

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, improving the accuracy of data collection and reimbursement processes related to high-risk pregnancies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions, improving the accuracy of data collection and reimbursement processes related to high-risk pregnancies.

Reimbursement & Billing Impact

reimbursement processes related to high-risk pregnancies.

Resources

Clinical References

  • •
    ACOG Practice Bulletin on Rhesus Isoimmunization

Coding & Billing References

  • •
    ACOG Practice Bulletin on Rhesus Isoimmunization

Frequently Asked Questions

What is the significance of coding O36.0?

Coding O36.0 is crucial for identifying pregnancies at risk for complications due to rhesus isoimmunization. It ensures that appropriate monitoring and interventions are documented and reimbursed, ultimately improving maternal and fetal outcomes.