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ICD-10 Guide
ICD-10 CodesO35.5

O35.5

Billable

Maternal care for (suspected) damage to fetus by drugs

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

Code Description

ICD-10 O35.5 is a billable code used to indicate a diagnosis of maternal care for (suspected) damage to fetus by drugs.

Key Diagnostic Point:

O35.5 refers to maternal care provided when there is a suspicion that the fetus may be adversely affected by drug exposure during pregnancy. This code encompasses a range of scenarios, including maternal use of prescription medications, over-the-counter drugs, and illicit substances. The potential impact on fetal development can lead to various abnormalities, including congenital malformations, neurodevelopmental disorders, and growth restrictions. Prenatal diagnosis may involve advanced imaging techniques and genetic testing to assess the extent of any damage. Maternal-fetal medicine specialists often play a crucial role in managing these cases, providing comprehensive care that includes counseling, monitoring, and intervention strategies to optimize outcomes for both mother and fetus. The complexity of care increases with the need for interdisciplinary collaboration, particularly when addressing the implications of drug exposure on fetal health.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Variety of drugs and their potential effects on fetal development
  • Need for thorough documentation of maternal drug history
  • Interdisciplinary collaboration required for management
  • Variability in fetal response to drug exposure

Audit Risk Factors

  • Inadequate documentation of maternal drug history
  • Failure to document prenatal diagnostic procedures
  • Misclassification of drug exposure severity
  • Lack of follow-up care documentation

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed maternal history including drug use, prenatal care visits, and any interventions taken.

Common Clinical Scenarios

Maternal use of antidepressants, opioids, or illicit drugs during pregnancy.

Billing Considerations

Consideration of the timing of drug exposure in relation to fetal development stages.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive risk assessment, imaging results, and genetic testing outcomes.

Common Clinical Scenarios

Management of pregnancies complicated by known drug exposure and associated fetal anomalies.

Billing Considerations

Coordination with genetic counselors and pediatric specialists for long-term planning.

Coding Guidelines

Inclusion Criteria

Use O35.5 When
  • Coders should adhere to the official ICD
  • CM guidelines, ensuring accurate documentation of maternal drug use and any related fetal conditions
  • Specific criteria for prenatal diagnosis and monitoring should be followed

Exclusion Criteria

Do NOT use O35.5 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 drug exposure and its implications.

Documentation Requirements

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

Specialty Considerations

Obstetricians should ensure thorough documentation to support the medical necessity of the visit.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of maternal-fetal conditions, enhancing the ability to capture the complexities of drug exposure and its effects on fetal health.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal-fetal conditions, enhancing the ability to capture the complexities of drug exposure and its effects on fetal health.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal-fetal conditions, enhancing the ability to capture the complexities of drug exposure and its effects on fetal health.

Resources

Clinical References

  • •
    CDC Guidelines on Substance Use in Pregnancy

Coding & Billing References

  • •
    CDC Guidelines on Substance Use in Pregnancy

Frequently Asked Questions

What types of drugs are considered under O35.5?

O35.5 encompasses all types of drugs, including prescription medications, over-the-counter drugs, and illicit substances that may pose a risk to fetal development.