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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.0

O35.0

Billable

Maternal care for (suspected) central nervous system malformation in fetus

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

Code Description

ICD-10 O35.0 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation in fetus.

Key Diagnostic Point:

O35.0 is used to indicate maternal care for a fetus suspected of having a central nervous system (CNS) malformation. This code encompasses a range of conditions that may affect the fetal brain and spinal cord, including but not limited to spina bifida, anencephaly, and encephalocele. Prenatal diagnosis often involves advanced imaging techniques such as ultrasound and MRI to identify potential abnormalities. Maternal care may include genetic counseling, additional monitoring, and planning for delivery in a specialized facility if necessary. The management of these cases requires a multidisciplinary approach, involving obstetricians, maternal-fetal medicine specialists, and pediatric neurologists to ensure optimal outcomes for both mother and child. Documentation must reflect the suspected diagnosis, the methods used for prenatal diagnosis, and any referrals made for further evaluation or management.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal diagnostic imaging interpretation
  • Involvement of multiple specialties in care management
  • Variability in fetal CNS malformations and their implications
  • Documentation of genetic counseling and testing results

Audit Risk Factors

  • Inadequate documentation of prenatal diagnostic procedures
  • Failure to document genetic counseling discussions
  • Misclassification of fetal abnormalities
  • Lack of follow-up documentation on management plans

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of maternal health, prenatal visits, and any imaging studies performed.

Common Clinical Scenarios

Routine prenatal visits where CNS malformations are suspected based on ultrasound findings.

Billing Considerations

Ensure that all findings are clearly documented and that any referrals for genetic counseling are noted.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, imaging results, and multidisciplinary consultations.

Common Clinical Scenarios

High-risk pregnancies where advanced imaging reveals potential CNS malformations.

Billing Considerations

Focus on the implications of findings for both maternal and fetal health, including potential delivery planning.

Coding Guidelines

Inclusion Criteria

Use O35.0 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the code is used in conjunction with appropriate documentation of prenatal care, diagnostic imaging, and any referrals made for further evaluation

Exclusion Criteria

Do NOT use O35.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

Ultrasound, fetal, transabdominal, real-time with image documentation

Clinical Scenario

Used during routine prenatal visits when CNS malformations are suspected.

Documentation Requirements

Document the findings of the ultrasound and any follow-up actions taken.

Specialty Considerations

Obstetricians should ensure that all imaging results are communicated to the patient and documented in the medical record.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal care for suspected fetal malformations, 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 care for suspected fetal malformations, 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 should be documented when using O35.0?

Documentation should include the reason for suspicion of CNS malformation, results of any imaging studies, genetic counseling discussions, and any referrals made for further evaluation.