O35.09X1 — Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 1
O35.09X1 is a billable, specific ICD-10-CM code for maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 1. It is valid for submission on a claim.
7th character "1" — fetus 1
One of the following 7th characters is to be assigned to each code under category O35. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be assigned when assigning a code from category O35 that has a 7th character of 1 through 9.
- 0
- not applicable or unspecified
- 1
- fetus 1
- 2
- fetus 2
- 3
- fetus 3
- 4
- fetus 4
- 5
- fetus 5
- 9
- other fetus
Risk adjustment
O35.09X1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
O35.09X1 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A55326Billing and Coding: Zika Virus Testing by PCR and ELISA Methods
Related codes at this level
Codes that share O35.09. If O35.09X1 is not quite right, the correct code is usually one of these.
- O35.09X0Maternal care for (suspected) other central nervous system malformation or damage in fetus, not applicable or unspecified
- O35.09X2Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 2
- O35.09X3Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 3
- O35.09X4Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 4
- O35.09X5Maternal care for (suspected) other central nervous system malformation or damage in fetus, fetus 5
- O35.09X9Maternal care for (suspected) other central nervous system malformation or damage in fetus, other fetus
Questions about O35.09X1
- Is O35.09X1 a billable ICD-10-CM code?
- Yes. O35.09X1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does O35.09X1 sit in the tabular list?
- Pregnancy, childbirth and the puerperium (O00-O9A), in the block Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48).