O36

O36: Maternal care for other fetal problems

Non-billable headerICD-10-CM

O36 is a non-billable header ICD-10-CM code for maternal care for other fetal problems. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

One of the following 7th characters is to be assigned to each code under category O36. 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 O36 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

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

encounter for suspected maternal and fetal conditions ruled out (Z03.7-)
placental transfusion syndromes (O43.0-)

Excludes2: not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

labor and delivery complicated by fetal stress (O77.-)

Includes

Conditions this code covers.

the listed conditions in the fetus as a reason for hospitalization or other obstetric care of the mother, or for termination of pregnancy

Other codes that can never be billed with O36

Their own Excludes1 notes name this code, so the conflict is not listed above.

Z03.7Encounter for suspected maternal and fetal conditions ruled out
O00.0Abdominal pregnancy
O02.1Missed abortion
O36.2Maternal care for hydrops fetalis
P95Stillbirth
R76.0Raised antibody titer
Z33.2Encounter for elective termination of pregnancy

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.

Code to one of these instead O36

9 child codes. Green means billable.