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v1.0.0
ICD-10 Guide
ICD-10 CodesO36.0115

O36.0115

Billable

Maternal care for anti-D [Rh] antibodies, first trimester (fetus 5)

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

Code Description

ICD-10 O36.0115 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, first trimester (fetus 5).

Key Diagnostic Point:

O36.0115 refers to maternal care for a pregnancy complicated by the presence of anti-D (Rh) antibodies during the first trimester, specifically for the fifth fetus. This condition arises when an Rh-negative mother is exposed to Rh-positive blood, leading to the development of antibodies that can affect the fetus. The presence of these antibodies can result in hemolytic disease of the newborn, fetal growth restriction, and fetal distress. Close monitoring is essential to assess fetal well-being, including regular ultrasounds to evaluate growth and amniotic fluid levels, as well as non-stress tests to monitor fetal heart rate patterns. Management may involve interventions such as Rh immunoglobulin administration to prevent further antibody formation and careful planning for delivery to mitigate risks associated with fetal anemia and other complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Understanding of maternal-fetal blood group incompatibility
  • Need for detailed documentation of maternal antibody screening
  • Monitoring protocols for fetal growth and distress
  • Coordination of care among multiple specialties

Audit Risk Factors

  • Inadequate documentation of maternal antibody status
  • Failure to document fetal monitoring results
  • Misclassification of fetal distress severity
  • Lack of clear treatment plans for managing Rh incompatibility

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include maternal blood type, antibody screening results, and any interventions performed.

Common Clinical Scenarios

Management of Rh-negative mothers with previous sensitization, monitoring for fetal growth restriction.

Billing Considerations

Ensure accurate coding of any additional complications that may arise during pregnancy.

Maternal-Fetal Medicine

Documentation Requirements

Detailed records of high-risk assessments, including ultrasound findings and fetal monitoring.

Common Clinical Scenarios

Complex cases involving multiple pregnancies or severe fetal anemia.

Billing Considerations

Focus on interdisciplinary communication and comprehensive care plans.

Coding Guidelines

Inclusion Criteria

Use O36.0115 When
  • Follow the official ICD
  • CM guidelines for obstetric coding, ensuring that the trimester and specific fetal number are accurately documented
  • Use additional codes as necessary to capture any complications

Exclusion Criteria

Do NOT use O36.0115 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

59400CPT Code

Obstetrical care including antepartum care, delivery, and postpartum care

Clinical Scenario

Used for comprehensive care of a patient with anti-D antibodies throughout pregnancy.

Documentation Requirements

Document all visits, assessments, and interventions related to the management of Rh incompatibility.

Specialty Considerations

Ensure coordination with maternal-fetal medicine specialists for high-risk cases.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage complications such as those related to anti-D antibodies.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage complications such as those related to anti-D antibodies.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the ability to track and manage complications such as those related to anti-D antibodies.

Resources

Clinical References

  • •
    ACOG Practice Bulletin on Rh Immunoglobulin

Coding & Billing References

  • •
    ACOG Practice Bulletin on Rh Immunoglobulin

Frequently Asked Questions

What is the significance of coding O36.0115 accurately?

Accurate coding of O36.0115 is crucial for ensuring appropriate management of Rh incompatibility, which can lead to serious fetal complications. It also impacts reimbursement and quality of care metrics.