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v1.0.0
ICD-10 Guide
ICD-10 CodesO36.0195

O36.0195

Billable

Maternal care for anti-D [Rh] antibodies, unspecified trimester (fetus 5)

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

Code Description

ICD-10 O36.0195 is a billable code used to indicate a diagnosis of maternal care for anti-d [rh] antibodies, unspecified trimester (fetus 5).

Key Diagnostic Point:

Maternal care for anti-D [Rh] antibodies is critical in managing pregnancies at risk for Rh incompatibility. This condition arises when an Rh-negative mother carries an Rh-positive fetus, leading to the potential for hemolytic disease of the newborn (HDN). The presence of anti-D antibodies can cause fetal problems such as anemia, jaundice, and even fetal distress due to compromised blood flow and oxygen delivery. Monitoring is essential throughout the pregnancy, especially in cases of fetal growth restriction, where the fetus may not be developing adequately due to placental insufficiency or other complications. Regular ultrasounds and Doppler studies are often employed to assess fetal well-being and growth patterns. The management may include interventions such as intrauterine transfusions or early delivery if the fetus is in distress. The unspecified trimester designation indicates that the care may be relevant at any stage of pregnancy, necessitating ongoing assessment and tailored management strategies to ensure the best outcomes for both mother and fetus.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in maternal antibody levels and their impact on fetal health.
  • Need for frequent monitoring and potential interventions.
  • Differentiation between mild and severe cases of Rh incompatibility.
  • Documentation of fetal monitoring results and maternal health status.

Audit Risk Factors

  • Inadequate documentation of maternal antibody levels.
  • Failure to document fetal monitoring and assessment results.
  • Misclassification of the trimester of care.
  • Lack of clarity on the severity of fetal distress or growth restriction.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed records of maternal health, antibody testing results, and fetal monitoring.

Common Clinical Scenarios

Routine monitoring of Rh-negative mothers, management of fetal growth restriction, and planning for delivery in cases of fetal distress.

Billing Considerations

Accurate coding requires understanding of the implications of anti-D antibodies on fetal health and the need for interdisciplinary communication.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors, including maternal history and fetal assessments.

Common Clinical Scenarios

Management of complex cases involving multiple fetal complications, including anemia and distress.

Billing Considerations

High-risk pregnancies necessitate thorough documentation of interventions and outcomes to support coding accuracy.

Coding Guidelines

Inclusion Criteria

Use O36.0195 When
  • According to ICD
  • 10 coding guidelines, accurate coding for maternal care requires specificity regarding the trimester and the presence of any complications
  • Documentation must reflect the ongoing assessment of both maternal and fetal health

Exclusion Criteria

Do NOT use O36.0195 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

76817CPT Code

Ultrasound, fetal, transabdominal, real-time with image documentation

Clinical Scenario

Used for monitoring fetal growth and well-being in pregnancies with anti-D antibodies.

Documentation Requirements

Document indications for ultrasound and findings related to fetal health.

Specialty Considerations

Obstetricians should ensure that ultrasound findings are clearly linked to the diagnosis of anti-D antibodies.

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 pregnancies affected by 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 pregnancies affected by anti-D antibodies. This specificity aids in better patient care and resource allocation.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What are the implications of anti-D antibodies during pregnancy?

Anti-D antibodies can lead to serious fetal complications, including hemolytic disease of the newborn. Careful monitoring and management are essential to mitigate risks and ensure fetal well-being.