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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.2

O35.2

Billable

Maternal care for (suspected) hereditary disease in fetus

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

Code Description

ICD-10 O35.2 is a billable code used to indicate a diagnosis of maternal care for (suspected) hereditary disease in fetus.

Key Diagnostic Point:

O35.2 is used to indicate maternal care for a fetus suspected of having a hereditary disease. This code encompasses a range of genetic conditions that may be identified through prenatal screening and diagnostic testing. Maternal care in this context involves comprehensive evaluation and management strategies aimed at addressing potential fetal abnormalities, including genetic disorders such as Down syndrome, cystic fibrosis, and sickle cell disease. Healthcare providers may utilize various diagnostic tools, including ultrasound, amniocentesis, and chorionic villus sampling (CVS), to assess the fetus's health and genetic status. The management plan may involve genetic counseling, multidisciplinary care coordination, and discussions regarding potential interventions or preparations for the birth of a child with special needs. Accurate coding is essential to ensure appropriate reimbursement and to reflect the complexity of care provided to the mother and fetus during this critical period.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of hereditary diseases and their implications for care
  • Need for detailed documentation of genetic testing and results
  • Coordination of care among multiple specialties
  • Potential for evolving clinical scenarios based on test results

Audit Risk Factors

  • Inadequate documentation of genetic counseling sessions
  • Failure to document the results of genetic testing
  • Lack of clear care plans based on test results
  • Misclassification of hereditary conditions

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include details of prenatal screenings, genetic counseling sessions, and any diagnostic tests performed.

Common Clinical Scenarios

Common scenarios include referrals for genetic counseling after abnormal screening results or family history of genetic disorders.

Billing Considerations

Coders must ensure that all relevant tests and consultations are documented to support the use of O35.2.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include comprehensive assessments of maternal and fetal health, including genetic evaluations.

Common Clinical Scenarios

Complex maternal-fetal scenarios may involve multiple consultations and interventions based on genetic findings.

Billing Considerations

Considerations include the need for ongoing monitoring and potential interventions based on the hereditary condition identified.

Coding Guidelines

Inclusion Criteria

Use O35.2 When
  • According to official coding guidelines, O35
  • 2 should be used when there is a suspicion of a hereditary disease in the fetus, supported by appropriate documentation of maternal care and any diagnostic procedures performed
  • Coders should ensure that the code reflects the specific hereditary condition suspected

Exclusion Criteria

Do NOT use O35.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81200CPT Code

Cystic fibrosis carrier screening

Clinical Scenario

Used when a pregnant woman is screened for cystic fibrosis due to family history.

Documentation Requirements

Documentation must include the reason for testing and results.

Specialty Considerations

Obstetricians should coordinate with genetic counselors for comprehensive care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of hereditary diseases, improving the accuracy of maternal care documentation and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of hereditary diseases, improving the accuracy of maternal care documentation 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 documentation is required to support the use of O35.2?

Documentation must include details of any genetic counseling sessions, results of genetic tests, and a clear care plan based on the findings. This ensures that the code accurately reflects the complexity of care provided.