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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.02

O35.02

Billable

Maternal care for (suspected) central nervous system malformation or damage in fetus, anencephaly

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

Code Description

ICD-10 O35.02 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, anencephaly.

Key Diagnostic Point:

O35.02 refers to maternal care provided for suspected central nervous system malformations or damage in the fetus, specifically anencephaly, a severe congenital condition characterized by the absence of a major portion of the brain, skull, and scalp. This condition arises during early fetal development and is often diagnosed through prenatal imaging techniques such as ultrasound or MRI. Maternal care for this condition involves comprehensive counseling regarding the implications of the diagnosis, potential outcomes, and options available to the parents. Genetic counseling may also be recommended to assess the risk of recurrence in future pregnancies. The management of pregnancies complicated by anencephaly often includes close monitoring and planning for delivery, as well as discussions about palliative care options for the newborn. The emotional and psychological support for the parents is also a critical component of care, given the challenging nature of the diagnosis.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal diagnosis and imaging interpretation.
  • Involvement of multidisciplinary teams including obstetricians, genetic counselors, and maternal-fetal medicine specialists.
  • Documentation of extensive counseling and care plans.
  • Potential for additional codes related to associated anomalies or complications.

Audit Risk Factors

  • Inadequate documentation of counseling and care plans.
  • Failure to capture associated conditions or anomalies.
  • Misinterpretation of imaging results leading to incorrect coding.
  • Lack of clarity on the timing of diagnosis and its implications for care.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of prenatal visits, imaging results, and counseling sessions is essential. Providers should document the discussions held with the patient regarding the diagnosis and management options.

Common Clinical Scenarios

Patients presenting with abnormal ultrasound findings, referrals for genetic counseling, and discussions about delivery planning for fetuses diagnosed with anencephaly.

Billing Considerations

Special attention should be given to the emotional support provided to the parents and the documentation of any referrals made for psychological support.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, detailed ultrasound findings, and any interventions or monitoring performed during the pregnancy.

Common Clinical Scenarios

Management of pregnancies with known fetal anomalies, including anencephaly, and coordination of care with pediatric specialists for post-delivery management.

Billing Considerations

Consideration of the implications of the diagnosis on future pregnancies and the need for genetic counseling.

Coding Guidelines

Inclusion Criteria

Use O35.02 When
  • According to ICD
  • 10 coding guidelines, O35
  • 02 should be used when there is a confirmed or suspected diagnosis of anencephaly
  • Coders must ensure that all relevant documentation is present to support the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use O35.02 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

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

Clinical Scenario

Used during routine prenatal visits to assess fetal anatomy and detect anomalies.

Documentation Requirements

Documentation of the ultrasound findings and any follow-up care or referrals.

Specialty Considerations

Obstetricians should ensure that the ultrasound report is comprehensive and includes all relevant findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like anencephaly, improving the accuracy of data collection and reimbursement processes. The granularity of ICD-10 codes helps in better tracking of maternal-fetal outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like anencephaly, improving the accuracy of data collection and reimbursement processes. The granularity of ICD-10 codes helps in better tracking of maternal-fetal outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. The granularity of ICD-10 codes helps in better tracking of maternal-fetal outcomes and resource allocation.

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 O35.02?

Coding O35.02 is crucial for accurately capturing the complexities of maternal care for pregnancies affected by anencephaly. It ensures that healthcare providers receive appropriate reimbursement for the extensive counseling and care required for these high-risk pregnancies.