2021 ICD-10-CM Code O36.5194

Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 4

Version 2021
Billable Code
7th Character Code
Unspecified Code
Maternity Diagnoses
Diagnoses For Females Only
MS-DRG Mapping

Valid for Submission

O36.5194 is a billable diagnosis code used to specify a medical diagnosis of maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 4. The code O36.5194 is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions.

The code O36.5194 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 O36.5194 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.

ICD-10:O36.5194
Short Description:Matern care for known or susp placntl insuff, unsp tri, fts4
Long Description:Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 4

Code Classification

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:

Convert O36.5194 to ICD-9 Code

The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code O36.5194 its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.

Information for Patients


Health Problems in Pregnancy

Every pregnancy has some risk of problems. You may have problems because of a health condition you had before you got pregnant. You could also develop a condition during pregnancy. Other causes of problems during pregnancy can include being pregnant with more than one baby, a health problem in a previous pregnancy, substance abuse during pregnancy, or being over age 35. Any of these can affect your health, the health of your baby, or both.

If you have a chronic condition, you should talk to your health care provider about how to minimize your risk before you get pregnant. Once you are pregnant, you may need a health care team to monitor your pregnancy. Some common conditions that can complicate a pregnancy include

Other conditions that can make pregnancy risky can happen while you are pregnant - for example, gestational diabetes and Rh incompatibility. Good prenatal care can help detect and treat them.

Some discomforts, like nausea, back pain, and fatigue, are common during pregnancy. Sometimes it is hard to know what is normal. Call your health care provider if something is bothering or worrying you.


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Code History

  • 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 (First year ICD-10-CM implemented into the HIPAA code set)