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ICD-10 Guide
ICD-10 CodesZ36.85

Z36.85

Encounter for antenatal screening for Streptococcus B

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

Code Description

ICD-10 Z36.85 is a billable code used to indicate a diagnosis of encounter for antenatal screening for streptococcus b.

Key Diagnostic Point:

Z36.85 is used to indicate an encounter for antenatal screening specifically for Group B Streptococcus (GBS), a common bacterium that can be found in the vagina or rectum of healthy women. Screening for GBS is a critical preventive measure during pregnancy, as it can significantly impact maternal and neonatal health. The screening typically occurs between 35 and 37 weeks of gestation and is essential for identifying women who may transmit the bacteria to their newborns during delivery. Factors influencing health status include access to prenatal care, socioeconomic status, and education level, which can affect a woman's likelihood of receiving timely screening. Social determinants such as housing stability, transportation access, and health literacy also play a role in ensuring that expectant mothers engage with healthcare services for necessary screenings. Preventive care through GBS screening can lead to interventions such as intrapartum antibiotic prophylaxis, reducing the risk of early-onset GBS disease in infants. Proper documentation of the encounter is crucial for coding accuracy and ensuring that the healthcare provider receives appropriate reimbursement for preventive services.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate gestational age documentation
  • Understanding of screening guidelines and timing
  • Differentiation from other antenatal encounters
  • Potential for co-morbid conditions affecting screening

Audit Risk Factors

  • Inadequate documentation of screening rationale
  • Failure to document gestational age at the time of screening
  • Lack of evidence for patient education on GBS risks
  • Incorrect sequencing of codes related to GBS screening

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation must include the date of the screening, gestational age, and any patient education provided regarding GBS.

Common Clinical Scenarios

Routine prenatal visits where GBS screening is performed, including discussions about the implications of positive results.

Billing Considerations

Consideration of social determinants such as access to care and education about GBS.

Public Health

Documentation Requirements

Documentation should include population-level data on GBS screening rates and outcomes.

Common Clinical Scenarios

Public health initiatives aimed at increasing awareness and screening rates for GBS among pregnant women.

Billing Considerations

Focus on tracking health disparities and access to screening services.

Coding Guidelines

Inclusion Criteria

Use Z36.85 When
  • Z codes are used to indicate encounters for preventive services and screenings
  • When coding Z36
  • 85, it should be sequenced appropriately based on the primary diagnosis
  • Payer requirements may vary, so it is essential to verify coverage for GBS screening under preventive services

Exclusion Criteria

Do NOT use Z36.85 When
No specific exclusions found.

Related CPT Codes

87430CPT Code

Streptococcus, Group B, test

Clinical Scenario

Used during the encounter for GBS screening at 35-37 weeks of gestation.

Documentation Requirements

Documentation must include the date of the test, results, and any follow-up care provided.

Specialty Considerations

Primary care providers should ensure that the screening aligns with current guidelines.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding related to antenatal screenings, improving the ability to track and manage maternal and neonatal health outcomes effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding related to antenatal screenings, improving the ability to track and manage maternal and neonatal health outcomes effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding related to antenatal screenings, improving the ability to track and manage maternal and neonatal health outcomes effectively.

Resources

Clinical References

  • •
    CDC Guidelines for Group B Streptococcus

Coding & Billing References

  • •
    CDC Guidelines for Group B Streptococcus

Frequently Asked Questions

What is the importance of GBS screening during pregnancy?

GBS screening is crucial as it helps identify pregnant women who carry the bacteria, allowing for timely interventions to prevent transmission to the newborn during delivery. This can significantly reduce the risk of serious infections in infants.