Version 2024

2024 ICD-10-CM Diagnosis Code O36.5990

Maternal care for other known or suspected poor fetal growth, unspecified trimester, not applicable or unspecified

ICD-10-CM Code:: O36.5990
ICD-10 Code for:: Matern care for oth or susp poor fetl grth, unsp tri, unsp
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
Code Navigator:

Code Information
Approximate Synonyms
Clinical Classification
Tabular List of Diseases and Injuries
Code Edits
Diagnostic Related Groups Mapping
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Pregnancy, childbirth and the puerperium
(O00-O9A)
- Maternal care related to the fetus and amniotic cavity and possible delivery problems
  (O30-O48)
  - Maternal care for other fetal problems
    (O36)

O36.5990 is a billable diagnosis code used to specify a medical diagnosis of maternal care for other known or suspected poor fetal growth, unspecified trimester, not applicable or unspecified. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

The code O36.5990 is applicable to female patients aged 12 through 55 years inclusive. It is clinically and virtually impossible to use this code on a non-female patient outside the stated age range.

Unspecified diagnosis codes like O36.5990 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Asymmetrical growth retardation
Asymmetrical small for gestational age fetus
Below expected growth rate
Disorder of fetal nutrition
Disorder of fetal nutrition
Disorder of fetal nutrition
Fetal growth abnormality
Fetal growth restriction
Fetus small-for-dates with signs of malnutrition
Finding of fetal growth
Light-for-dates with signs of fetal malnutrition
Light-for-dates without fetal malnutrition
Poor clinical fetal growth
Poor fetal growth affecting management
Poor fetal nutrition
Size of fetus - finding
Small fetus
Small for gestational age fetus
Symmetrical growth retardation
Twins with discordant fetal growth

Clinical Classification

Clinical Category is Maternal care related to fetal conditions
CCSR Category Code: PRG013
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:

Maternity diagnoses - The Medicare Code Editor detects inconsistencies in maternity cases by checking a patient's age and any diagnosis on the patient's record. The maternity code edits apply to patients age ange is 9–64 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).
Diagnoses for females only - The Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, these edits apply to FEMALES only .

O36.5990 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
817	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC	14	2.255
818	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC	14	1.1731
819	OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC	14	0.9072

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert O36.5990 to ICD-9-CM

ICD-9-CM Code: 656.50 - Poor fetal growth-unspec
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

O36 Maternal care for other fetal problems.
O36.0 Maternal care for rhesus isoimmunization.
O36.01 Maternal care for anti-D [Rh] antibodies.
O36.011 Maternal care for anti-D [Rh] antibodies, first trimester.
O36.0110 Maternal care for anti-D [Rh] antibodies, first trimester, not applicable or unspecified.
O36.0111 Maternal care for anti-D [Rh] antibodies, first trimester, fetus 1.
O36.0112 Maternal care for anti-D [Rh] antibodies, first trimester, fetus 2.
O36.0113 Maternal care for anti-D [Rh] antibodies, first trimester, fetus 3.
O36.0114 Maternal care for anti-D [Rh] antibodies, first trimester, fetus 4.
O36.0115 Maternal care for anti-D [Rh] antibodies, first trimester, fetus 5.
O36.0119 Maternal care for anti-D [Rh] antibodies, first trimester, other fetus.
O36.012 Maternal care for anti-D [Rh] antibodies, second trimester.
O36.0120 Maternal care for anti-D [Rh] antibodies, second trimester, not applicable or unspecified.
O36.0121 Maternal care for anti-D [Rh] antibodies, second trimester, fetus 1.
O36.0122 Maternal care for anti-D [Rh] antibodies, second trimester, fetus 2.
O36.0123 Maternal care for anti-D [Rh] antibodies, second trimester, fetus 3.
O36.0124 Maternal care for anti-D [Rh] antibodies, second trimester, fetus 4.
O36.0125 Maternal care for anti-D [Rh] antibodies, second trimester, fetus 5.
O36.0129 Maternal care for anti-D [Rh] antibodies, second trimester, other fetus.
O36.013 Maternal care for anti-D [Rh] antibodies, third trimester.
O36.0130 Maternal care for anti-D [Rh] antibodies, third trimester, not applicable or unspecified.
O36.0131 Maternal care for anti-D [Rh] antibodies, third trimester, fetus 1.
O36.0132 Maternal care for anti-D [Rh] antibodies, third trimester, fetus 2.
O36.0133 Maternal care for anti-D [Rh] antibodies, third trimester, fetus 3.
O36.0134 Maternal care for anti-D [Rh] antibodies, third trimester, fetus 4.
O36.0135 Maternal care for anti-D [Rh] antibodies, third trimester, fetus 5.
O36.0139 Maternal care for anti-D [Rh] antibodies, third trimester, other fetus.
O36.019 Maternal care for anti-D [Rh] antibodies, unspecified trimester.
O36.0190 Maternal care for anti-D [Rh] antibodies, unspecified trimester, not applicable or unspecified.
O36.0191 Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 1.
O36.0192 Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 2.
O36.0193 Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 3.
O36.0194 Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 4.
O36.0195 Maternal care for anti-D [Rh] antibodies, unspecified trimester, fetus 5.
O36.0199 Maternal care for anti-D [Rh] antibodies, unspecified trimester, other fetus.
O36.09 Maternal care for other rhesus isoimmunization.
O36.091 Maternal care for other rhesus isoimmunization, first trimester.
O36.0910 Maternal care for other rhesus isoimmunization, first trimester, not applicable or unspecified.
O36.0911 Maternal care for other rhesus isoimmunization, first trimester, fetus 1.
O36.0912 Maternal care for other rhesus isoimmunization, first trimester, fetus 2.
O36.0913 Maternal care for other rhesus isoimmunization, first trimester, fetus 3.
O36.0914 Maternal care for other rhesus isoimmunization, first trimester, fetus 4.
O36.0915 Maternal care for other rhesus isoimmunization, first trimester, fetus 5.
O36.0919 Maternal care for other rhesus isoimmunization, first trimester, other fetus.
O36.092 Maternal care for other rhesus isoimmunization, second trimester.
O36.0920 Maternal care for other rhesus isoimmunization, second trimester, not applicable or unspecified.
O36.0921 Maternal care for other rhesus isoimmunization, second trimester, fetus 1.
O36.0922 Maternal care for other rhesus isoimmunization, second trimester, fetus 2.
O36.0923 Maternal care for other rhesus isoimmunization, second trimester, fetus 3.
O36.0924 Maternal care for other rhesus isoimmunization, second trimester, fetus 4.
O36.0925 Maternal care for other rhesus isoimmunization, second trimester, fetus 5.

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.