2025 ICD-10-CM code O36
(Active) Effective Date: N/A Revision Date: N/A Obstetrics - Maternal care related to the fetus and amniotic cavity and possible delivery problems XV Pregnancy, childbirth and the puerperium Feed
Maternal care for other known or suspected fetal problems.
Modifiers may be applicable depending on the specific services rendered and the context of care. Consult relevant guidelines for appropriate modifier application.
Medical necessity is established when there are objective findings indicating a potential risk to the fetus, necessitating close monitoring and/or intervention to optimize the outcome of the pregnancy.Documentation must support the clinical rationale for the provided care.
The clinical responsibility falls on the obstetrician or other qualified healthcare professional managing the pregnancy.This may involve performing tests, providing counseling, managing complications, and coordinating with specialists as needed.
- XV Pregnancy, childbirth and the puerperium
- O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems
In simple words: This code is used when a mother receives medical care because of problems with her baby during pregnancy.These problems aren't listed specifically elsewhere, and might include issues found through testing or because of concerns about the baby's health.
This code encompasses maternal care provided due to various known or suspected fetal issues not specifically categorized elsewhere within the O36 range.It includes situations where the fetus is a reason for maternal hospitalization or other obstetric care, or for termination of pregnancy.Examples may involve conditions detected through testing or observation that raise concern for fetal well-being, necessitating maternal intervention or monitoring.
Example 1: A pregnant woman undergoes an ultrasound that reveals suspected fetal growth restriction.Maternal care is initiated to monitor fetal well-being and manage the pregnancy appropriately., A pregnant woman is admitted to the hospital due to concerns about decreased fetal movement.Further investigations are undertaken, and O36 is used to reflect maternal care related to the uncertain fetal condition., A pregnant woman receives counseling and monitoring after receiving genetic testing revealing a chromosomal abnormality.
Detailed ultrasound reports, fetal monitoring strips, laboratory test results, maternal history, and physician's notes outlining the reason for concern and the provided care are crucial for accurate coding.
** This code is very broad and should only be used when a more specific code within the O36 range does not apply.Always use the most specific code possible to ensure accurate reimbursement.
- Payment Status: Active
- Specialties:Obstetrics, Maternal-Fetal Medicine
- Place of Service:Office, Hospital (Inpatient or Outpatient), Birthing Center