O36.5

O36.5: Maternal care for known or suspected poor fetal growth

Non-billable headerICD-10-CM

O36.5 is a non-billable header ICD-10-CM code for maternal care for known or suspected poor fetal growth. 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 inherited from the categories above O36.5

A category’s note binds every code beneath it.

Written on O36: Maternal care for other fetal problems

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

Excludes2 inherited from the categories above O36.5

Not part of this code, but both may be coded when both are present.

Written on O36: Maternal care for other fetal problems

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

Other codes that can never be billed with O36.5

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

Z03.7Encounter for suspected maternal and fetal conditions ruled out

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 O36.5

2 child codes. Green means billable.