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v1.0.0
ICD-10 Guide
ICD-10 CodesO36.0130

O36.0130

Billable

Maternal care for anti-D [Rh] antibodies, third trimester (not applicable or unspecified)

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

Code Description

ICD-10 O36.0130 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, third trimester (not applicable or unspecified).

Key Diagnostic Point:

O36.0130 refers to maternal care for women who have developed anti-D (Rh) antibodies during pregnancy, particularly in the third trimester. This condition arises when an Rh-negative mother is exposed to Rh-positive fetal blood, leading to the production of antibodies that can cross the placenta and potentially harm the fetus. The clinical implications include risks of hemolytic disease of the newborn, fetal growth restriction, and fetal distress. Monitoring and management strategies may involve serial ultrasounds to assess fetal growth, non-stress tests to evaluate fetal well-being, and possible interventions such as intrauterine transfusions if severe anemia is detected. The complexity of care increases as the pregnancy progresses, necessitating close surveillance and coordination among obstetricians, maternal-fetal medicine specialists, and pediatricians to ensure optimal outcomes for both mother and child.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate identification of maternal Rh status
  • Monitoring for fetal growth restriction and distress
  • Coordination of care among multiple specialties
  • Documentation of serial ultrasounds and fetal assessments

Audit Risk Factors

  • Inadequate documentation of maternal Rh status
  • Failure to document fetal monitoring results
  • Lack of evidence for interventions performed
  • Misclassification of fetal distress severity

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of maternal history, Rh status, and fetal assessments is essential. Providers should document any interventions and the rationale for monitoring strategies.

Common Clinical Scenarios

Common scenarios include routine monitoring of an Rh-negative mother with a known Rh-positive partner, management of fetal growth restriction, and addressing fetal distress during labor.

Billing Considerations

Coders must ensure that all relevant clinical findings and interventions are documented to support the use of O36.0130.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include detailed assessments of fetal well-being, growth parameters, and any therapeutic interventions.

Common Clinical Scenarios

Complex maternal-fetal scenarios may involve multiple ultrasounds, consultations for intrauterine transfusions, and management of severe fetal anemia.

Billing Considerations

High-risk coding requires careful attention to detail and thorough documentation of all clinical interactions and decisions.

Coding Guidelines

Inclusion Criteria

Use O36.0130 When
  • According to official coding guidelines, O36
  • 0130 should be used when maternal care is provided for anti
  • D antibodies in the third trimester, particularly when there are no specific complications documented
  • Coders should ensure that the code reflects the current clinical status and any interventions performed

Exclusion Criteria

Do NOT use O36.0130 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 routine monitoring of fetal growth in mothers with anti-D antibodies.

Documentation Requirements

Documentation must include indications for ultrasound and findings.

Specialty Considerations

Obstetricians should ensure that ultrasound findings are clearly linked to the diagnosis of anti-D antibodies.

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 ability to capture the complexities of cases involving anti-D antibodies and their implications for fetal health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions, improving the ability to capture the complexities of cases involving anti-D antibodies and their implications for fetal health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal conditions, improving the ability to capture the complexities of cases involving anti-D antibodies and their implications for fetal health.

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 O36.0130?

Coding O36.0130 is crucial for accurately reflecting the maternal care provided for women with anti-D antibodies, which can have significant implications for fetal health. Proper coding ensures appropriate monitoring and intervention strategies are documented and reimbursed.