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v1.0.0
ICD-10 Guide
ICD-10 CodesO12.1

O12.1

Billable

Gestational proteinuria

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/08/2025

Code Description

ICD-10 O12.1 is a billable code used to indicate a diagnosis of gestational proteinuria.

Key Diagnostic Point:

Gestational proteinuria is a condition characterized by the presence of excess protein in the urine during pregnancy, typically occurring after the 20th week of gestation. It is important to note that this condition arises without the presence of hypertension, distinguishing it from preeclampsia. Gestational proteinuria can be associated with gestational edema, which is the swelling caused by fluid retention in the body, particularly in the lower extremities. The diagnosis is made through urine tests that reveal protein levels exceeding normal thresholds. While gestational proteinuria itself may not pose immediate risks, it can be indicative of underlying issues that may require monitoring and management. Clinicians must carefully evaluate the patient's overall health, including kidney function and any potential complications. Management may involve lifestyle modifications, dietary adjustments, and regular monitoring to ensure the health of both the mother and the fetus. Accurate coding of this condition is crucial for proper treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational proteinuria and other hypertensive disorders of pregnancy.
  • Understanding the implications of proteinuria in the absence of hypertension.
  • Documenting the severity and duration of proteinuria accurately.
  • Recognizing associated conditions such as gestational edema.

Audit Risk Factors

  • Inadequate documentation of protein levels and urine tests.
  • Failure to differentiate from preeclampsia or gestational hypertension.
  • Lack of follow-up documentation regarding management and outcomes.
  • Misclassification of gestational proteinuria as a chronic condition.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include urine test results, symptoms, and any management plans.

Common Clinical Scenarios

A pregnant patient presenting with swelling and proteinuria during a routine check-up.

Billing Considerations

Ensure clear differentiation from hypertensive disorders and document any interventions.

Maternal-Fetal Medicine

Documentation Requirements

Detailed records of maternal and fetal assessments, including ultrasound findings and laboratory results.

Common Clinical Scenarios

Management of a high-risk pregnancy with gestational proteinuria and monitoring for potential complications.

Billing Considerations

Focus on the implications of proteinuria for fetal health and potential interventions.

Coding Guidelines

Inclusion Criteria

Use O12.1 When
  • Follow the official ICD
  • CM guidelines for coding pregnancy
  • related conditions, ensuring accurate documentation of gestational proteinuria without hypertension
  • Include relevant clinical findings and management details

Exclusion Criteria

Do NOT use O12.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81002CPT Code

Urinalysis, automated, with microscopy

Clinical Scenario

Used to evaluate protein levels in urine during routine prenatal visits.

Documentation Requirements

Document the reason for urinalysis and results clearly.

Specialty Considerations

Obstetricians should ensure that the urinalysis is part of routine prenatal care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gestational conditions, improving the accuracy of diagnoses and treatment plans. O12.1 provides a clear distinction from other hypertensive disorders, facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gestational conditions, improving the accuracy of diagnoses and treatment plans. O12.1 provides a clear distinction from other hypertensive disorders, facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gestational conditions, improving the accuracy of diagnoses and treatment plans. O12.1 provides a clear distinction from other hypertensive disorders, facilitating better patient management.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between gestational proteinuria and preeclampsia?

Gestational proteinuria occurs without hypertension, while preeclampsia is characterized by both elevated blood pressure and proteinuria. Accurate documentation is essential to differentiate between these conditions.