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O35 ICD-10-CM Code: Maternal care for known or suspected fetal abnormality and damage

ICD-10-CM Code View

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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)

O35

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Maternal care for known or suspected fetal abnormality and damage

Maternal care for known or suspected fetal abnormality and damage

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
O3Maternal care related to the fetus and amniotic cavity and possible delivery problems (O30-O48)
O35Maternal care for known or suspected fetal abnormality and damage

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for O35 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for O35 in this effective period.

Related Child Codes

Official
O35.0Maternal care for (suspected) central nervous system malformation in fetus
O35.1Maternal care for (suspected) chromosomal abnormality in fetus
O35.2Maternal care for (suspected) hereditary disease in fetus
O35.3Maternal care for (suspected) damage to fetus from viral disease in mother
O35.4Maternal care for (suspected) damage to fetus from alcohol

Includes

Official
  • the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy

Excludes 1

Official
  • encounter for suspected maternal and fetal conditions ruled out (Z03.7-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for O35 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for O35 in this effective period.

Code Also

Official
  • any associated maternal condition

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Coder workflow notes

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What This Code Means

O35 is the ICD-10-CM diagnosis code for maternal care for known or suspected fetal abnormality and damage. O35 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering maternal care related to the fetus and amniotic cavity and possible delivery problems (o30-o48).

Header codes like O35 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at O35's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O35 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Includes

  • the listed conditions in the fetus as a reason for hospitalization or other obstetric care to the mother, or for termination of pregnancy

Excludes 1, Do NOT code together

  • encounter for suspected maternal and fetal conditions ruled out (Z03.7-)

Code Also

  • any associated maternal condition

Child Codes

Code Hierarchy

O35Maternal care for known or suspected fetal abnormality and damage
O35Maternal care for known or suspected fetal abnormality and damage

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