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v1.0.0
ICD-10 Guide
ICD-10 CodesO36.011

O36.011

Billable

Maternal care for anti-D [Rh] antibodies, first trimester

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

Code Description

ICD-10 O36.011 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, first trimester.

Key Diagnostic Point:

Maternal care for anti-D [Rh] antibodies during the first trimester is critical for managing potential fetal complications associated with Rh incompatibility. When a Rh-negative mother carries a Rh-positive fetus, the mother's immune system may produce antibodies against the Rh factor, leading to hemolytic disease of the newborn (HDN). This condition can result in fetal problems such as intrauterine growth restriction (IUGR), fetal distress, and even fetal demise if not monitored and managed appropriately. Early identification and management of anti-D antibodies are essential to prevent severe outcomes. Maternal care includes regular monitoring of maternal antibody levels, ultrasound assessments to evaluate fetal growth and well-being, and potential interventions such as Rh immunoglobulin administration to prevent sensitization. The first trimester is a crucial period for intervention, as early detection can significantly improve maternal and fetal outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate identification of maternal Rh status
  • Monitoring of antibody titers and fetal well-being
  • Potential for multiple fetal complications requiring interdisciplinary care
  • Documentation of maternal and fetal assessments

Audit Risk Factors

  • Inadequate documentation of maternal antibody testing
  • Failure to note fetal monitoring results
  • Incorrect coding of fetal complications
  • Lack of clarity in the documentation of Rh immunoglobulin administration

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include maternal Rh status, antibody screening results, and any interventions performed.

Common Clinical Scenarios

Management of a Rh-negative mother with a known Rh-positive partner, monitoring for signs of fetal distress or growth restriction.

Billing Considerations

Coders must ensure that all relevant maternal and fetal assessments are documented to support the diagnosis.

Maternal-Fetal Medicine

Documentation Requirements

Detailed documentation of high-risk assessments, including ultrasound findings and maternal-fetal interactions.

Common Clinical Scenarios

Complex cases involving multiple gestations or previous pregnancies affected by Rh incompatibility.

Billing Considerations

High-risk pregnancies require thorough documentation of all interventions and outcomes to justify coding.

Coding Guidelines

Inclusion Criteria

Use O36.011 When
  • Coders should follow official ICD
  • 10 guidelines for obstetric coding, ensuring that the code is used in conjunction with appropriate documentation of maternal and fetal assessments
  • Specific criteria for coding maternal conditions must be met, including the timing of the diagnosis and the presence of any complications

Exclusion Criteria

Do NOT use O36.011 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

36415CPT Code

Blood typing, Rh factor

Clinical Scenario

Used to determine maternal Rh status during prenatal visits.

Documentation Requirements

Document the reason for testing and results.

Specialty Considerations

Obstetricians must ensure accurate documentation of Rh testing in high-risk pregnancies.

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, improving the ability to track and manage complications related to anti-D antibodies. This specificity aids in better patient care and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of maternal conditions, improving the ability to track and manage complications related to anti-D antibodies. This specificity aids in better patient care and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of maternal conditions, improving the ability to track and manage complications related to anti-D antibodies. This specificity aids in better patient care and resource allocation.

Resources

Clinical References

  • •
    CDC Guidelines on Rh Incompatibility

Coding & Billing References

  • •
    CDC Guidelines on Rh Incompatibility

Frequently Asked Questions

What is the significance of coding O36.011?

Coding O36.011 is crucial for identifying and managing pregnancies at risk for Rh incompatibility, ensuring appropriate maternal and fetal care is documented and reimbursed.