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v1.0.0
ICD-10 Guide
ICD-10 CodesO35.9

O35.9

Billable

Maternal care for (suspected) fetal abnormality and damage, unspecified

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

Code Description

ICD-10 O35.9 is a billable code used to indicate a diagnosis of maternal care for (suspected) fetal abnormality and damage, unspecified.

Key Diagnostic Point:

O35.9 is used to indicate maternal care for suspected fetal abnormalities or damage when the specific nature of the abnormality is not identified. This code encompasses a range of conditions where there is concern regarding the fetus's development, which may include genetic disorders, structural anomalies, or other abnormalities detected through prenatal screening or imaging. Maternal care in this context often involves comprehensive prenatal assessments, including ultrasounds, genetic counseling, and possibly invasive diagnostic procedures such as amniocentesis or chorionic villus sampling (CVS). The management of these cases requires a multidisciplinary approach, involving obstetricians, maternal-fetal medicine specialists, genetic counselors, and pediatricians to ensure optimal outcomes for both the mother and the fetus. Documentation must reflect the clinical findings, the rationale for the suspicion of abnormality, and the plan for further evaluation and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of suspected fetal abnormalities
  • Need for detailed clinical history and prenatal testing results
  • Potential for multiple co-existing conditions complicating coding
  • Variations in clinical guidelines for managing suspected abnormalities

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document follow-up care or referrals
  • Misinterpretation of ultrasound findings
  • Lack of clear communication between specialties

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include details of prenatal visits, ultrasound findings, and any genetic counseling provided.

Common Clinical Scenarios

Common scenarios include abnormal ultrasound findings, positive genetic screening tests, and maternal concerns regarding fetal health.

Billing Considerations

Accurate coding requires clear documentation of the suspected abnormality and the rationale for further testing or referrals.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation must include detailed assessments, diagnostic tests, and management plans.

Common Clinical Scenarios

Complex maternal-fetal scenarios may involve multiple risk factors, such as advanced maternal age or family history of genetic disorders.

Billing Considerations

Considerations for high-risk obstetric coding include the need for comprehensive documentation of all assessments and interventions.

Coding Guidelines

Inclusion Criteria

Use O35.9 When
  • According to the official ICD
  • 10 coding guidelines, O35
  • 9 should be used when there is a suspicion of fetal abnormality without a specific diagnosis
  • Coders must ensure that the documentation supports the use of this code, including any relevant prenatal testing and follow
  • up care

Exclusion Criteria

Do NOT use O35.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76811CPT Code

Ultrasound, pregnant uterus, transabdominal, real-time with image documentation

Clinical Scenario

Used during routine prenatal visits when fetal abnormalities are suspected.

Documentation Requirements

Documentation must include the reason for the ultrasound and findings.

Specialty Considerations

Obstetricians should ensure that all findings are clearly documented to support coding.

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 ability to track and manage care for suspected fetal abnormalities. O35.9 provides a broad category for cases where the specific abnormality is not yet identified.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the ability to track and manage care for suspected fetal abnormalities. O35.9 provides a broad category for cases where the specific abnormality is not yet identified.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal and fetal conditions, improving the ability to track and manage care for suspected fetal abnormalities. O35.9 provides a broad category for cases where the specific abnormality is not yet identified.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should O35.9 be used?

O35.9 should be used when there is a suspicion of fetal abnormality without a specific diagnosis. This includes cases where further testing is planned to clarify the condition.