2025 ICD-10-CM code O36.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Maternal care related to the fetus and amniotic cavity and possible delivery problems - Maternal care for other known or suspected fetal problems Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Maternal care for other isoimmunization.
Modifiers might be applicable depending on the circumstances of the care provided.Refer to the official guidelines for modifier usage.
Medical necessity for code O36.1 is established by the presence of maternal isoimmunization (excluding ABO) that poses a risk to the fetus.The need for close monitoring, testing, or treatment to prevent or manage complications related to this incompatibility justifies the use of this code.Clinical judgment should be used to determine the appropriateness of this code on a case-by-case basis.
The clinical responsibility involves the obstetrician or maternal-fetal medicine specialist who manages the pregnancy, monitors the mother and fetus for complications arising from the isoimmunization, and provides appropriate interventions as needed. This may include administering medications, performing blood transfusions, and managing potential complications such as fetal hydrops.
- Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
- O00-O99 > O30-O48 > O36 > O36.1
In simple words: This code is used when a mother needs medical care because of a problem with her blood type not matching her baby's blood type (excluding ABO incompatibility).The care might involve testing and treatment to keep the baby safe and healthy.
This code signifies maternal medical care necessitated by isoimmunization other than ABO incompatibility.It encompasses various conditions arising from the incompatibility between maternal and fetal blood types, excluding ABO incompatibility, which requires a different code.The care provided may include monitoring, testing, and treatment aimed at preventing or managing complications related to this incompatibility.
Example 1: A pregnant woman with Rh incompatibility (other than ABO) is monitored regularly with ultrasound and blood tests to detect any signs of hemolysis in the fetus.This would necessitate code O36.1., A pregnant woman with a history of Kell blood group incompatibility experiences a sudden drop in fetal hemoglobin levels.She undergoes close monitoring and receives medication to manage the isoimmunization.Code O36.1 accurately reflects the clinical situation., A mother with a history of previous pregnancies complicated by isoimmunization undergoes a more rigorous testing protocol to detect any antibody production.This entails code O36.1 to capture maternal care focused on preventing isoimmunization related issues.
Detailed maternal medical history, including prior pregnancies, blood type and Rh factor information for both mother and fetus, complete prenatal records, fetal monitoring data (ultrasound findings and Doppler studies), laboratory results (blood test results including antibody titers), treatment records (medications administered and their dosages), and any complications encountered.
** Code O36.1 should only be applied to maternal records.Never use this code on newborn records.Careful documentation is essential for proper reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Obstetrics, Maternal-Fetal Medicine, Hematology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Birthing Center