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ICD-10 Guide
ICD-10 CodesO36.0191

O36.0191

Billable

Maternal care for anti-D [Rh] antibodies, unspecified trimester (fetus 1)

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

Code Description

ICD-10 O36.0191 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, unspecified trimester (fetus 1).

Key Diagnostic Point:

Maternal care for anti-D [Rh] antibodies is critical in managing pregnancies where the mother has developed antibodies against the Rh factor, which can lead to hemolytic disease of the fetus and newborn (HDFN). This condition arises when an Rh-negative mother carries an Rh-positive fetus, leading to the mother's immune system producing antibodies that can cross the placenta and attack fetal red blood cells. The clinical management of this condition involves careful monitoring of the fetus for signs of anemia, growth restriction, and distress. Regular ultrasounds and Doppler studies may be employed to assess fetal well-being and blood flow. Maternal care may also include administering Rh immunoglobulin (RhoGAM) to prevent antibody formation in future pregnancies. The unspecified trimester designation indicates that the care may be applicable at any point during the pregnancy, necessitating ongoing assessment and intervention as needed to ensure both maternal and fetal health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate identification of maternal antibody status.
  • Monitoring for fetal complications such as anemia and growth restriction.
  • Documentation of maternal and fetal assessments over time.
  • Coordination of care among multiple specialties, including obstetrics and maternal-fetal medicine.

Audit Risk Factors

  • Inadequate documentation of maternal antibody testing.
  • Failure to document fetal monitoring results.
  • Lack of clarity on the trimester of care.
  • Improper coding of associated fetal conditions.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal antibody status, fetal assessments, and any interventions performed.

Common Clinical Scenarios

Routine monitoring of Rh-negative mothers, administration of RhoGAM, and management of fetal distress.

Billing Considerations

Ensure that all maternal and fetal assessments are documented clearly to support coding.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, including ultrasound findings and fetal blood flow studies.

Common Clinical Scenarios

Management of severe fetal anemia, intrauterine transfusions, and close monitoring of growth restriction.

Billing Considerations

High-risk pregnancies require detailed documentation of all interventions and outcomes.

Coding Guidelines

Inclusion Criteria

Use O36.0191 When
  • Follow official ICD
  • 10 guidelines for obstetric coding, ensuring that the trimester is documented and that any associated fetal conditions are coded appropriately
  • The use of additional codes for fetal complications may be necessary

Exclusion Criteria

Do NOT use O36.0191 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

Document all visits, assessments, and interventions related to the pregnancy.

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 maternal conditions related to Rh incompatibility, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

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

Reimbursement & Billing Impact

reimbursement processes.

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 anti-D antibodies in pregnancy?

Anti-D antibodies can lead to serious complications in pregnancies where the mother is Rh-negative and the fetus is Rh-positive. It is crucial to monitor the pregnancy closely to prevent hemolytic disease of the newborn.