O36.5199 Maternal care for known or suspected placental insufficiency, unspecified trimester, other fetus

Billable ICD-10-CM code, FY2026.

Built from O36.519 with 7th character 9 (other fetus).

Applies from O36 Maternal care for other fetal problems

Includes

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

Excludes1 (never code together)

• encounter for suspected maternal and fetal conditions ruled out (Z03.7-)
• placental transfusion syndromes (O43.0-)

Excludes2 (not included here)

• labor and delivery complicated by fetal stress (O77.-)

7th character note

• One of the following 7th characters is to be assigned to each code under category O36. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be assigned when assigning a code from category O36 that has a 7th character of 1 through 9.

7th character required

• 0 — not applicable or unspecified
• 1 — fetus 1
• 2 — fetus 2
• 3 — fetus 3
• 4 — fetus 4
• 5 — fetus 5
• 9 — other fetus

Medicare Code Edits (MCE v43.1 (April 2026))

• Maternity diagnoses (age 9 through 64): Age conflict edit. These diagnoses are clinically expected only in patients age 9 through 64.

Code annotations containing back-references to O36.5199

Back-references to O36.5

• Type 2 Excludes: O43 Placental disorders ("maternal care for poor fetal growth due to placental insufficiency (O36.5-)")

Back-references to O36

• Type 2 Excludes: O98 Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium ("when the reason for maternal care is that the disease is known or suspected to have affected the fetus (O35-O36)")
• Type 2 Excludes: O99 Other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium ("when the reason for maternal care is that the condition is known or suspected to have affected the fetus (O35-O36)")
• Type 1 Excludes: Z03.7 Encounter for suspected maternal and fetal conditions ruled out ("known or suspected fetal anomalies affecting management of mother, not ruled out (O26.-, O35.-, O36.-, O40.-, O41.-)")

Nearby codes

• O36.5191 Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 1
• O36.5192 Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 2
• O36.5193 Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 3
• O36.5194 Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 4
• O36.5195 Maternal care for known or suspected placental insufficiency, unspecified trimester, fetus 5
• O36.5199 Maternal care for known or suspected placental insufficiency, unspecified trimester, other fetus (this code)
• O36.59 Maternal care for other known or suspected poor fetal growth
• O36.591 Maternal care for other known or suspected poor fetal growth, first trimester
• O36.5910 Maternal care for other known or suspected poor fetal growth, first trimester, not applicable or unspecified
• O36.5911 Maternal care for other known or suspected poor fetal growth, first trimester, fetus 1
• O36.5912 Maternal care for other known or suspected poor fetal growth, first trimester, fetus 2