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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.03

O35.03

Billable

Maternal care for (suspected) central nervous system malformation or damage in fetus, choroid plexus cysts

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

Code Description

ICD-10 O35.03 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, choroid plexus cysts.

Key Diagnostic Point:

O35.03 is used to indicate maternal care for suspected central nervous system malformations or damage in the fetus, specifically related to choroid plexus cysts. Choroid plexus cysts are fluid-filled sacs that can develop in the brain's choroid plexus, which produces cerebrospinal fluid. While often benign and resolving spontaneously, their presence can be associated with chromosomal abnormalities, such as trisomy 18. Maternal care involves thorough prenatal diagnosis, including ultrasound evaluations and genetic counseling, to assess the risk of associated conditions. The management may include additional imaging studies, consultations with maternal-fetal medicine specialists, and discussions regarding the implications for the pregnancy. Accurate coding is essential for tracking maternal and fetal health outcomes and ensuring appropriate care is provided throughout the pregnancy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between benign and concerning findings on ultrasound.
  • Understanding the implications of choroid plexus cysts in relation to genetic conditions.
  • Navigating the documentation requirements for high-risk pregnancies.
  • Coordinating care among multiple specialties, including obstetrics and genetics.

Audit Risk Factors

  • Inadequate documentation of ultrasound findings.
  • Failure to document genetic counseling discussions.
  • Misclassification of the severity of fetal abnormalities.
  • Lack of follow-up documentation for suspected conditions.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include detailed ultrasound reports, maternal history, and any genetic counseling provided.

Common Clinical Scenarios

Routine prenatal visits where choroid plexus cysts are identified during ultrasound screenings.

Billing Considerations

Ensure that all findings are clearly documented to support the coding of suspected fetal abnormalities.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, including genetic testing results and follow-up plans.

Common Clinical Scenarios

Consultations for patients with identified choroid plexus cysts and potential genetic implications.

Billing Considerations

Focus on the interdisciplinary approach to managing high-risk pregnancies and the importance of thorough documentation.

Coding Guidelines

Inclusion Criteria

Use O35.03 When
  • Follow the official ICD
  • CM guidelines for coding maternal care and fetal conditions
  • Ensure that the documentation supports the diagnosis and reflects the complexity of care provided

Exclusion Criteria

Do NOT use O35.03 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

Ultrasound, pregnant uterus, transabdominal, real-time with image documentation, fetal and maternal evaluation

Clinical Scenario

Used during routine prenatal visits when choroid plexus cysts are identified.

Documentation Requirements

Document the findings of the ultrasound and any follow-up recommendations.

Specialty Considerations

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 fetal conditions, improving the accuracy of maternal care documentation and facilitating better tracking of outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fetal conditions, improving the accuracy of maternal care documentation and facilitating better tracking of outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fetal conditions, improving the accuracy of maternal care documentation and facilitating better tracking of outcomes.

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 coding O35.03?

Documentation should include detailed ultrasound findings, any genetic counseling provided, and follow-up plans for the pregnancy. Ensure that all relevant maternal and fetal health information is captured.