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ICD-10 Guide
ICD-10 CodesO35.11

O35.11

Billable

Maternal care for (suspected) chromosomal abnormality in fetus, Trisomy 13

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

Code Description

ICD-10 O35.11 is a billable code used to indicate a diagnosis of maternal care for (suspected) chromosomal abnormality in fetus, trisomy 13.

Key Diagnostic Point:

O35.11 refers to maternal care provided for a suspected chromosomal abnormality in the fetus, specifically Trisomy 13, also known as Patau syndrome. This condition is characterized by the presence of an extra chromosome 13, leading to severe developmental and physical abnormalities. Maternal care for this condition typically involves comprehensive prenatal screening and diagnostic testing, including non-invasive prenatal testing (NIPT), chorionic villus sampling (CVS), or amniocentesis to confirm the diagnosis. The management of pregnancies affected by Trisomy 13 requires a multidisciplinary approach, often involving obstetricians, maternal-fetal medicine specialists, genetic counselors, and pediatricians. Counseling regarding the implications of the diagnosis, potential outcomes, and options for care is crucial. The complexity of care increases as the pregnancy progresses, necessitating close monitoring and potential interventions to manage maternal and fetal health effectively.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Need for accurate prenatal screening and diagnostic testing interpretation
  • Multidisciplinary care coordination among specialists
  • Counseling requirements for parents regarding prognosis and options
  • Documentation of detailed maternal and fetal assessments

Audit Risk Factors

  • Inadequate documentation of genetic counseling sessions
  • Failure to document the results of prenatal testing
  • Lack of detailed notes on maternal and fetal assessments
  • Misclassification of the severity of the chromosomal abnormality

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of prenatal visits, including ultrasound findings and genetic counseling notes.

Common Clinical Scenarios

Routine prenatal visits with additional assessments for suspected chromosomal abnormalities.

Billing Considerations

Ensure all genetic testing results are documented and discussed with the patient.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk assessments, including maternal health and fetal monitoring.

Common Clinical Scenarios

Management of pregnancies with confirmed Trisomy 13, including potential interventions.

Billing Considerations

Focus on the implications of the diagnosis for both maternal and fetal health.

Coding Guidelines

Inclusion Criteria

Use O35.11 When
  • Follow the official ICD
  • CM guidelines for coding maternal conditions and ensure that all documentation supports the diagnosis
  • Specific criteria for coding suspected chromosomal abnormalities must be met, including the need for genetic counseling and testing

Exclusion Criteria

Do NOT use O35.11 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76817CPT Code

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

Clinical Scenario

Used for routine monitoring of fetal development in pregnancies with suspected chromosomal abnormalities.

Documentation Requirements

Detailed ultrasound reports documenting fetal anatomy and any abnormalities.

Specialty Considerations

Obstetricians should ensure that all findings are clearly documented for coding purposes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the accuracy of diagnoses and the ability to track outcomes for conditions like Trisomy 13.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the accuracy of diagnoses and the ability to track outcomes for conditions like Trisomy 13.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the accuracy of diagnoses and the ability to track outcomes for conditions like Trisomy 13.

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 O35.11?

Coding O35.11 is crucial for identifying pregnancies at risk for Trisomy 13, allowing for appropriate management and counseling for the parents. Accurate coding ensures that healthcare providers can track outcomes and provide necessary interventions.