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ICD-10 Guide
ICD-10 CodesO12.13

O12.13

Billable

Gestational proteinuria, third trimester

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

Code Description

ICD-10 O12.13 is a billable code used to indicate a diagnosis of gestational proteinuria, third trimester.

Key Diagnostic Point:

Gestational proteinuria is characterized by the presence of excess protein in the urine during pregnancy, specifically in the third trimester, without the presence of hypertension. This condition often arises due to physiological changes in the renal system during pregnancy, where increased blood volume and altered renal hemodynamics can lead to transient proteinuria. While gestational proteinuria can be benign, it is crucial to monitor for potential progression to more serious conditions such as preeclampsia. Clinicians should assess the patient's history, perform urinalysis, and evaluate for any signs of edema, which may accompany proteinuria. The absence of hypertension differentiates this condition from preeclampsia, making it essential for accurate diagnosis and management. Regular monitoring and appropriate documentation are vital to ensure the health of both the mother and the fetus.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational proteinuria and preeclampsia.
  • Understanding the physiological changes in renal function during pregnancy.
  • Accurate documentation of urine protein levels and associated symptoms.
  • Monitoring for potential complications that may arise from gestational proteinuria.

Audit Risk Factors

  • Inadequate documentation of urine protein levels.
  • Failure to note the absence of hypertension.
  • Misclassification of gestational proteinuria as preeclampsia.
  • Lack of follow-up documentation on the patient's condition.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed urinalysis results, patient history, and symptomatology.

Common Clinical Scenarios

Routine prenatal visits where proteinuria is detected during urinalysis.

Billing Considerations

Ensure clear differentiation from hypertensive disorders of pregnancy.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive assessment of maternal and fetal health, including risk factors for preeclampsia.

Common Clinical Scenarios

Management of high-risk pregnancies with proteinuria and potential complications.

Billing Considerations

Focus on monitoring for progression to severe conditions.

Coding Guidelines

Inclusion Criteria

Use O12.13 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring that gestational proteinuria is documented accurately, particularly noting the absence of hypertension

Exclusion Criteria

Do NOT use O12.13 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81002CPT Code

Urinalysis, automated, with microscopy

Clinical Scenario

Used during routine prenatal visits to assess for proteinuria.

Documentation Requirements

Document the results of urinalysis and any symptoms reported by the patient.

Specialty Considerations

Ensure that the urinalysis is performed in accordance with obstetric guidelines.

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 for pregnant patients.

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 for pregnant patients.

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 for pregnant patients.

Resources

Clinical References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Coding & Billing References

  • •
    American College of Obstetricians and Gynecologists (ACOG)

Frequently Asked Questions

What is the significance of coding O12.13 accurately?

Accurate coding of O12.13 is crucial for proper management of the patient's condition and for ensuring appropriate reimbursement for services rendered. It helps in tracking maternal and fetal health outcomes and in identifying potential complications.