ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesO35.4

O35.4

Billable

Maternal care for (suspected) damage to fetus from alcohol

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

Code Description

ICD-10 O35.4 is a billable code used to indicate a diagnosis of maternal care for (suspected) damage to fetus from alcohol.

Key Diagnostic Point:

O35.4 is used to indicate maternal care for a fetus suspected to be damaged due to maternal alcohol consumption during pregnancy. This code is critical in identifying potential fetal alcohol spectrum disorders (FASD), which can lead to a range of physical, behavioral, and learning problems in the child. The documentation should reflect the maternal history of alcohol use, any prenatal diagnostic tests performed, and the assessment of fetal abnormalities. Prenatal care may include genetic counseling, ultrasound evaluations, and other diagnostic imaging to monitor fetal development and identify any abnormalities. It is essential for healthcare providers to document the extent of alcohol exposure, the timing during pregnancy, and any interventions or referrals made for further evaluation or support. This code emphasizes the importance of maternal health and the potential impact of substance use on fetal development, guiding healthcare providers in delivering appropriate care and counseling.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for detailed maternal history regarding alcohol use.
  • Potential for multiple fetal abnormalities requiring comprehensive documentation.
  • Variability in clinical presentation of fetal alcohol spectrum disorders.
  • Requirement for interdisciplinary collaboration for accurate diagnosis and management.

Audit Risk Factors

  • Inadequate documentation of maternal alcohol use.
  • Failure to document prenatal diagnostic tests performed.
  • Misclassification of fetal abnormalities related to alcohol exposure.
  • Lack of interdisciplinary notes regarding maternal-fetal care.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed maternal history, including substance use, prenatal visits, and any referrals for counseling or support.

Common Clinical Scenarios

Pregnant women presenting with concerns about alcohol use, referrals for genetic counseling, and monitoring of fetal development through ultrasounds.

Billing Considerations

Accurate documentation of the timing and amount of alcohol exposure is crucial for proper coding and management.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessments of fetal health, including genetic testing results and detailed ultrasound findings.

Common Clinical Scenarios

High-risk pregnancies with suspected fetal alcohol syndrome, requiring close monitoring and multidisciplinary care.

Billing Considerations

Collaboration with genetic counselors and pediatric specialists to address potential long-term effects on the child.

Coding Guidelines

Inclusion Criteria

Use O35.4 When
  • According to the official ICD
  • 10 coding guidelines, O35
  • 4 should be used when there is a documented suspicion of fetal damage due to maternal alcohol use
  • Coders must ensure that the documentation supports the diagnosis and reflects the clinical scenario accurately
  • It is essential to follow guidelines for coding maternal conditions that affect the fetus, including the use of additional codes for specific fetal abnormalities

Exclusion Criteria

Do NOT use O35.4 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99203CPT Code

Office or other outpatient visit for the evaluation and management of a new patient

Clinical Scenario

Used during prenatal visits when discussing maternal alcohol use and its implications.

Documentation Requirements

Document the patient's history, risk factors, and any counseling provided.

Specialty Considerations

Obstetricians should ensure that all relevant details about maternal substance use are included.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal conditions affecting fetal health, such as O35.4. This specificity aids in better tracking of fetal alcohol spectrum disorders and enhances the ability to provide targeted interventions and support.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions affecting fetal health, such as O35.4. This specificity aids in better tracking of fetal alcohol spectrum disorders and enhances the ability to provide targeted interventions and support.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal conditions affecting fetal health, such as O35.4. This specificity aids in better tracking of fetal alcohol spectrum disorders and enhances the ability to provide targeted interventions and support.

Resources

Clinical References

  • •
    CDC Fetal Alcohol Spectrum Disorders (FASD)

Coding & Billing References

  • •
    CDC Fetal Alcohol Spectrum Disorders (FASD)

Frequently Asked Questions

What documentation is needed to support the use of code O35.4?

To support the use of O35.4, documentation should include a detailed maternal history of alcohol use, results from any prenatal diagnostic tests, and assessments of fetal health. It is also important to document any referrals for genetic counseling or additional evaluations.