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ICD-10 Guide
ICD-10 CodesO35.05

O35.05

Billable

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

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

Code Description

ICD-10 O35.05 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, holoprosencephaly.

Key Diagnostic Point:

Holoprosencephaly is a congenital brain malformation resulting from the failure of the embryonic forebrain to properly divide into two hemispheres. This condition can lead to a spectrum of abnormalities ranging from mild facial deformities to severe neurological deficits. Maternal care for suspected holoprosencephaly involves comprehensive prenatal screening, including detailed ultrasounds and genetic counseling. The diagnosis may be suspected based on abnormal ultrasound findings, such as a single central ventricle or facial anomalies. Genetic testing may also be indicated to identify chromosomal abnormalities associated with holoprosencephaly. Maternal care focuses on monitoring the pregnancy closely, providing emotional support, and discussing potential outcomes and management options with the parents. This includes planning for delivery in a facility equipped to handle potential complications and ensuring appropriate postnatal care for the infant.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for detailed prenatal diagnostic testing and interpretation
  • Involvement of multiple specialties (e.g., genetics, maternal-fetal medicine)
  • Variability in presentation and severity of the condition
  • Potential for associated anomalies requiring additional coding

Audit Risk Factors

  • Inadequate documentation of diagnostic tests performed
  • Failure to document maternal counseling and decision-making
  • Misclassification of the severity of the condition
  • Inconsistent coding of associated anomalies

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include detailed ultrasound findings, genetic counseling notes, and maternal discussions regarding the implications of the diagnosis.

Common Clinical Scenarios

Prenatal visits where ultrasound findings suggest holoprosencephaly, genetic counseling sessions, and discussions about delivery planning.

Billing Considerations

Ensure that all findings are clearly documented and that the rationale for any interventions or referrals is included.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include comprehensive assessments of fetal well-being, maternal health, and any interventions planned.

Common Clinical Scenarios

Management of pregnancies with suspected fetal anomalies, including detailed imaging and genetic testing.

Billing Considerations

Focus on the multidisciplinary approach and ensure that all specialists involved in care are documented.

Coding Guidelines

Inclusion Criteria

Use O35.05 When
  • Follow official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical documentation and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use O35.05 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 for detailed fetal imaging when holoprosencephaly is suspected.

Documentation Requirements

Document the findings, including any anomalies noted during the ultrasound.

Specialty Considerations

Ensure that the ultrasound is performed by a qualified technician and interpreted by a specialist.

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 holoprosencephaly, 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 conditions like holoprosencephaly, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 O35.05?

Coding O35.05 is crucial for identifying pregnancies at risk for significant fetal anomalies, allowing for appropriate prenatal care and planning for delivery.