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v1.0.0
ICD-10 Guide
ICD-10 CodesZ36.5

Z36.5

Encounter for antenatal screening for isoimmunization

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 Z36.5 is a billable code used to indicate a diagnosis of encounter for antenatal screening for isoimmunization.

Key Diagnostic Point:

Z36.5 is used to indicate an encounter for antenatal screening specifically aimed at detecting isoimmunization, a condition where a pregnant woman’s immune system produces antibodies against the red blood cells of the fetus. This screening is crucial for preventing hemolytic disease of the newborn, which can lead to serious complications. Factors influencing health status include maternal age, previous pregnancy history, and blood type compatibility. Social determinants such as access to healthcare, socioeconomic status, and education level can impact the likelihood of receiving timely screening. Preventive care through early detection allows for appropriate management strategies, including monitoring and potential interventions like Rh immunoglobulin administration. This code is essential for ensuring that pregnant individuals receive comprehensive care that addresses both medical and social factors affecting their health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of maternal-fetal medicine and isoimmunization risks.
  • Documentation must include specific details about the screening process.
  • Knowledge of related laboratory tests and their implications.
  • Awareness of social determinants affecting patient access to care.

Audit Risk Factors

  • Inadequate documentation of the screening process.
  • Failure to link the encounter to appropriate clinical indications.
  • Misunderstanding of isoimmunization and its implications.
  • Incorrect sequencing of codes related to pregnancy complications.

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, screening results, and any follow-up care plans.

Common Clinical Scenarios

Routine prenatal visits where screening for isoimmunization is performed.

Billing Considerations

Consideration of social determinants such as access to prenatal care and education on the importance of screening.

Public Health

Documentation Requirements

Documentation should focus on population health data, screening rates, and outcomes related to isoimmunization.

Common Clinical Scenarios

Community health initiatives aimed at increasing awareness and screening for isoimmunization.

Billing Considerations

Tracking health disparities and access to care in different populations.

Coding Guidelines

Inclusion Criteria

Use Z36.5 When
  • Z codes are used primarily for encounters that do not involve a current illness or injury but rather for preventive care and screenings
  • When using Z36
  • 5, it should be sequenced appropriately with any relevant diagnosis codes
  • Payer requirements may vary, so it is essential to verify coverage for screening services

Exclusion Criteria

Do NOT use Z36.5 When
No specific exclusions found.

Related CPT Codes

85025CPT Code

Complete blood count (CBC) with isoimmunization screening

Clinical Scenario

Used during the prenatal visit when screening for isoimmunization is performed.

Documentation Requirements

Document the reason for the CBC and the results of the isoimmunization screening.

Specialty Considerations

Primary care providers should ensure comprehensive prenatal care documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of antenatal screenings, including isoimmunization, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of antenatal screenings, including isoimmunization, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    CDC Guidelines on Prenatal Care

Coding & Billing References

  • •
    CDC Guidelines on Prenatal Care

Frequently Asked Questions

What is the importance of screening for isoimmunization during pregnancy?

Screening for isoimmunization is crucial as it helps prevent hemolytic disease of the newborn, which can lead to severe complications. Early detection allows for timely interventions, improving maternal and fetal outcomes.