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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.1

O35.1

Billable

Maternal care for (suspected) chromosomal abnormality in fetus

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

Code Description

ICD-10 O35.1 is a billable code used to indicate a diagnosis of maternal care for (suspected) chromosomal abnormality in fetus.

Key Diagnostic Point:

O35.1 is used to indicate maternal care for a fetus suspected of having a chromosomal abnormality. This code is relevant in cases where prenatal screening tests, such as non-invasive prenatal testing (NIPT) or amniocentesis, suggest the possibility of conditions like Down syndrome, Turner syndrome, or other genetic disorders. Maternal care involves comprehensive monitoring and counseling, including genetic counseling, ultrasound assessments, and possibly further diagnostic testing. The management of pregnancies with suspected chromosomal abnormalities requires a multidisciplinary approach, often involving obstetricians, geneticists, and maternal-fetal medicine specialists. The goal is to provide the mother with information regarding the implications of the findings, potential outcomes, and options available, including continuation of the pregnancy, further testing, or preparation for potential interventions at birth.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate interpretation of prenatal screening results
  • Coordination of care among multiple specialties
  • Documentation of informed consent for genetic testing
  • Variability in clinical management based on specific abnormalities

Audit Risk Factors

  • Inadequate documentation of counseling provided to the patient
  • Failure to document the results of genetic testing
  • Lack of clear indication of the suspected chromosomal abnormality
  • Improper linkage of diagnosis to the appropriate maternal care services

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include details of prenatal screenings, results, counseling sessions, and any referrals made for genetic testing.

Common Clinical Scenarios

A patient undergoing routine prenatal care who receives abnormal screening results and is referred for further evaluation.

Billing Considerations

Ensure that all discussions regarding risks and options are documented, including the patient's understanding and decisions made.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include detailed assessments, follow-up plans, and any interventions considered.

Common Clinical Scenarios

A high-risk pregnancy where advanced imaging and genetic testing are utilized to assess fetal health.

Billing Considerations

Consider the implications of findings on delivery planning and postnatal care.

Coding Guidelines

Inclusion Criteria

Use O35.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when there is a documented suspicion of a chromosomal abnormality
  • Documentation must support the medical necessity for the care provided

Exclusion Criteria

Do NOT use O35.1 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 assessment when chromosomal abnormalities are suspected.

Documentation Requirements

Document the reason for the ultrasound and findings related to the suspected abnormality.

Specialty Considerations

Ensure that the ultrasound report is linked to the diagnosis of suspected chromosomal abnormality.

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 related to fetal abnormalities, 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 related to fetal abnormalities, 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 should be documented when using O35.1?

Documentation should include the results of any prenatal screening tests, details of genetic counseling provided, and any follow-up plans or referrals made for further testing.