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ICD-10 Guide
ICD-10 CodesO35.08

O35.08

Billable

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

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

Code Description

ICD-10 O35.08 is a billable code used to indicate a diagnosis of maternal care for (suspected) central nervous system malformation or damage in fetus, spina bifida.

Key Diagnostic Point:

O35.08 is used to indicate maternal care for a fetus suspected of having a central nervous system malformation, specifically spina bifida. Spina bifida is a neural tube defect that occurs when the spine does not close completely during fetal development, leading to varying degrees of disability. Maternal care for this condition involves comprehensive prenatal assessments, including ultrasound examinations and genetic counseling, to evaluate the extent of the malformation and its potential impact on the fetus. The management may include multidisciplinary approaches involving obstetricians, maternal-fetal medicine specialists, and pediatric neurosurgeons. Prenatal diagnosis is crucial for planning delivery and postnatal care, as well as for counseling the parents regarding the prognosis and potential interventions. The care plan may also involve discussions about the risks of associated conditions, such as hydrocephalus and Chiari malformation, which can accompany spina bifida. Accurate coding is essential for appropriate reimbursement and to ensure that the healthcare team is aware of the complexities involved in managing pregnancies affected by fetal abnormalities.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for detailed documentation of prenatal diagnostic tests and results.
  • Variability in clinical presentation and severity of spina bifida.
  • Coordination of care among multiple specialties.
  • Potential for associated anomalies requiring additional coding.

Audit Risk Factors

  • Inadequate documentation of prenatal diagnostic procedures.
  • Failure to update coding based on ultrasound findings.
  • Misclassification of the severity of the condition.
  • Lack of coordination notes among specialists.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of prenatal visits, including ultrasound reports and maternal health assessments.

Common Clinical Scenarios

Routine prenatal visits with findings of suspected fetal abnormalities, referrals for genetic counseling.

Billing Considerations

Ensure all findings are documented clearly to support the diagnosis and coding.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, including detailed ultrasound findings and genetic testing results.

Common Clinical Scenarios

Management of pregnancies with confirmed or suspected fetal anomalies requiring specialized care.

Billing Considerations

Focus on the multidisciplinary approach and coordination of care among specialists.

Coding Guidelines

Inclusion Criteria

Use O35.08 When
  • According to ICD
  • 10 coding guidelines, O35
  • 08 should be used when there is a suspicion of central nervous system malformation in the fetus, supported by appropriate diagnostic testing
  • Documentation must reflect the clinical findings and the rationale for the diagnosis

Exclusion Criteria

Do NOT use O35.08 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

Ultrasound, fetal, transabdominal, real-time with image documentation, fetal biometry and/or doppler evaluation

Clinical Scenario

Used during routine prenatal visits when spina bifida is suspected.

Documentation Requirements

Detailed ultrasound report indicating findings related to spina bifida.

Specialty Considerations

Obstetricians should ensure that all findings are documented to support the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fetal abnormalities, including spina bifida, which enhances the ability to track and manage these conditions effectively. It has improved the granularity of data for research and quality improvement initiatives in obstetric care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fetal abnormalities, including spina bifida, which enhances the ability to track and manage these conditions effectively. It has improved the granularity of data for research and quality improvement initiatives in obstetric care.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What documentation is required to support the use of code O35.08?

To support the use of code O35.08, documentation must include detailed ultrasound findings, any genetic counseling notes, and a clear care plan that outlines the management of the suspected fetal condition. All prenatal visits should reflect the ongoing assessment and any referrals made.