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ICD-10 Guide
ICD-10 CodesO36.0190

O36.0190

Billable

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

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

Code Description

ICD-10 O36.0190 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, unspecified trimester (not applicable or unspecified).

Key Diagnostic Point:

Maternal care for anti-D [Rh] antibodies refers to the management and monitoring of pregnant women who have developed antibodies against the Rh factor, which can lead to hemolytic disease of the newborn (HDN). This condition arises when an Rh-negative mother carries an Rh-positive fetus, leading to potential complications such as fetal anemia, hydrops fetalis, and intrauterine growth restriction (IUGR). The unspecified trimester designation indicates that the timing of the maternal care is not clearly defined, which can complicate management strategies. Clinicians must closely monitor fetal growth and well-being through ultrasound assessments and non-stress tests to detect any signs of fetal distress or growth restriction. The management may include administering Rh immunoglobulin (RhoGAM) to prevent antibody formation in future pregnancies and ensuring appropriate follow-up care to monitor fetal health throughout the pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation of Rh sensitization.
  • Need for detailed documentation of maternal and fetal monitoring.
  • Potential for multiple follow-up visits and interventions.
  • Differentiation between mild and severe cases of fetal distress.

Audit Risk Factors

  • Inadequate documentation of maternal antibody status.
  • Failure to document fetal monitoring results.
  • Misclassification of the trimester of care.
  • Lack of follow-up notes on fetal growth assessments.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include maternal blood type, antibody screening results, and details of fetal monitoring.

Common Clinical Scenarios

Management of an Rh-negative mother with a known Rh-positive partner, monitoring for fetal anemia.

Billing Considerations

Accurate coding requires clear documentation of the trimester and any interventions performed.

Maternal-Fetal Medicine

Documentation Requirements

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

Common Clinical Scenarios

Complex cases involving fetal growth restriction due to Rh incompatibility.

Billing Considerations

High-risk pregnancies necessitate comprehensive documentation of all interventions and outcomes.

Coding Guidelines

Inclusion Criteria

Use O36.0190 When
  • According to ICD
  • 10 guidelines, accurate coding requires documentation of the maternal condition, trimester, and any related fetal complications
  • The unspecified trimester code should be used when the timing of care is not clearly documented

Exclusion Criteria

Do NOT use O36.0190 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 obstetric care in patients with anti-D antibodies.

Documentation Requirements

Complete documentation of all prenatal visits and interventions.

Specialty Considerations

Obstetricians must ensure thorough records of maternal and fetal assessments.

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. O36.0190 provides a clear framework for documenting maternal care related to anti-D antibodies.

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. O36.0190 provides a clear framework for documenting maternal care related to anti-D antibodies.

Reimbursement & Billing Impact

reimbursement processes. O36.0190 provides a clear framework for documenting maternal care related to anti-D antibodies.

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 is the significance of coding O36.0190?

Coding O36.0190 is crucial for tracking maternal health conditions related to Rh incompatibility, ensuring appropriate care and monitoring for potential fetal complications.