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Question: A pregnant patient was seen by a neonatologist due to the fetus having a suspected cleft palate. An MRI was performed, which confirmed the presence of a cleft palate. Would a code from O36 be appropriate for that diagnosis? The fact that the fetal condition exists does not justify assigning a code from this series to the mother’s record, correct?

AAPC Forum Participant

Answer: Based on your scenario and the code descriptor, ICD-10-CM code O35.AXX1 (Maternal care for other (suspected) fetal abnormality and damage, fetal facial abnormalities) would be most appropriate.

Keep in mind that with the above code, you must code to the 7^th character, and the number “1” indicates this fetal abnormality is pertaining to one fetus.

Make note: Per the ICD-10-CM guidelines, “Codes from categories O35, Maternal care for known or suspected fetal abnormality and damage, and O36, Maternal care for other fetal problems, are assigned only when the fetal condition is actually responsible for modifying the management of the mother, i.e., by requiring diagnostic studies, additional observation, special care, or termination of pregnancy.”

Based on the guidelines, the fetal condition (cleft palate) has necessitated an MRI, which is a diagnostic study. Therefore, it has modified the management of the mother, and it would be appropriate to assign the O35.AXX1 code to the mother’s record.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC