ICD-10-CM Code O35.4XX5

Maternal care for (suspected) damage to fetus from alcohol, fetus 5

Version 2020 Billable Code Maternity Diagnoses Diagnoses For Females Only

Valid for Submission

O35.4XX5 is a billable code used to specify a medical diagnosis of maternal care for (suspected) damage to fetus from alcohol, fetus 5. The code is valid for the year 2020 for the submission of HIPAA-covered transactions.

The code O35.4XX5 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.

ICD-10:O35.4XX5
Short Description:Maternal care for damage to fetus from alcohol, fetus 5
Long Description:Maternal care for (suspected) damage to fetus from alcohol, fetus 5

Code Edits

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

  • Maternity diagnoses - Maternity. Age range is 12–55 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).
  • Diagnoses for females only - Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, this code applies to FEMALES only .

Diagnostic Related Groups

The ICD-10 code O35.4XX5 is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.

  • 817 - OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH MCC
  • 818 - OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITH CC
  • 819 - OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURE WITHOUT CC/MCC

Convert O35.4XX5 to ICD-9

  • 655.41 - Fet damg d/t dis-deliver (Approximate Flag)
  • 655.43 - Fet damg d/t dis-antepar (Approximate Flag)

Code Classification

  • Pregnancy, childbirth and the puerperium (O00–O99)
    • Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)
      • Maternal care for known or suspected fetal abnlt and damage (O35)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Fetal Alcohol Spectrum Disorders

Alcohol can harm your baby at any stage during a pregnancy. That includes the earliest stages, before you even know you are pregnant. Drinking during pregnancy can cause a group of conditions called fetal alcohol spectrum disorders (FASDs). Children who are born with FASD can have a mix of problems, such as medical, behavioral, educational, and social problems. The kinds of problems they have depend on which type of FASD they have. The problems could include

  • Abnormal facial features, such as a smooth ridge between the nose and upper lip
  • Small head size
  • Shorter-than-average height
  • Low body weight
  • Poor coordination
  • Hyperactive behavior
  • Difficulty with attention and memory
  • Learning disabilities and difficulty in school
  • Speech and language delays
  • Intellectual disability or low IQ
  • Poor reasoning and judgment skills
  • Sleep and sucking problems as a baby
  • Vision or hearing problems
  • Problems with the heart, kidneys, or bones

Fetal alcohol syndrome (FAS) is the most serious type of FASD. People with fetal alcohol syndrome have facial abnormalities, including wide-set and narrow eyes, growth problems and nervous system abnormalities.

Diagnosing FASD can be hard because there is no medical test for it. The health care provider will make a diagnosis by looking at the child's signs and symptoms, and will ask whether the mother drank alcohol during pregnancy.

FASDs last a lifetime. There is no cure for FASDs, but treatments can help. These include medicines to help with some symptoms, medical care for health problems, behavior and education therapy, and parent training. A good treatment plan is specific to the child's problems. It should include close monitoring, follow-ups, and changes when needed.

Certain "protective factors" can help reduce the effects of FASDs and help people who have them reach their full potential. They include

  • Diagnosis before 6 years of age
  • Loving, nurturing, and stable home environment during the school years
  • Absence of violence around them
  • Involvement in special education and social services

There is no known safe amount of alcohol during pregnancy. To prevent FASDs, you should not drink alcohol while you are pregnant, or when you might get pregnant.

Centers for Disease Control and Prevention


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Pregnancy and Drug Use

When you are pregnant, you are not just "eating for two." You also breathe and drink for two. If you smoke, use alcohol or take illegal drugs, so does your unborn baby.

To protect your baby, you should avoid

  • Tobacco. Smoking during pregnancy passes nicotine, carbon monoxide, and other harmful chemicals to your baby. This could cause many problems for your unborn baby's development. It raises the risk of your baby being born too small, too early, or with birth defects. Smoking can also affect babies after they are born. Your baby would be more likely to develop diseases such as asthma and obesity. There is also a higher risk of dying from sudden infant death syndrome (SIDS).
  • Drinking alcohol. There is no known amount of alcohol that is safe for a woman to drink during pregnancy. If you drink alcohol when you are pregnant, your child could be born with lifelong fetal alcohol syndrome disorders (FASD). Children with FASD can have a mix of physical, behavioral, and learning problems.
  • Illegal drugs. Using illegal drugs such as cocaine and methamphetamines may cause underweight babies, birth defects, or withdrawal symptoms after birth.
  • Misusing prescription drugs. If you are taking prescription medicines, carefully follow your health care provider's instructions. It can be dangerous to take more medicines than you are supposed to, use them to get high, or take someone else's medicines. For example, misusing opioids can cause birth defects, withdrawal in the baby, or even loss of the baby.

If you are pregnant and you are doing any of these things, get help. Your healthcare provider can recommend programs to help you quit. You and your baby's health depend on it.

Dept. of Health and Human Services Office on Women's Health


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