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ICD-10 Guide
ICD-10 CodesO12.2

O12.2

Billable

Gestational edema with proteinuria

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

Code Description

ICD-10 O12.2 is a billable code used to indicate a diagnosis of gestational edema with proteinuria.

Key Diagnostic Point:

Gestational edema with proteinuria refers to the accumulation of excess fluid in the tissues of a pregnant woman, accompanied by the presence of protein in the urine, without the presence of hypertension. This condition typically arises during the second or third trimester of pregnancy and can be indicative of underlying issues such as preeclampsia or gestational hypertension, although in this specific code, hypertension is not present. The edema may manifest as swelling in the legs, feet, and hands, while proteinuria is detected through routine urinalysis. It is essential for healthcare providers to monitor these symptoms closely, as they can lead to more severe complications if left unaddressed. Proper management includes regular monitoring of the patient's weight, blood pressure, and urine protein levels, along with lifestyle modifications and, in some cases, medication to manage symptoms and prevent progression to more serious conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational edema and other types of edema.
  • Accurate identification of proteinuria levels and their clinical significance.
  • Monitoring for progression to conditions like preeclampsia.
  • Documentation of symptoms and laboratory findings.

Audit Risk Factors

  • Inadequate documentation of proteinuria levels.
  • Failure to document the absence of hypertension.
  • Misclassification of edema type.
  • Lack of follow-up notes on the patient's condition.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include detailed notes on the patient's symptoms, urinalysis results, and any interventions taken.

Common Clinical Scenarios

A pregnant patient presenting with swelling in the extremities and a positive urine dipstick for protein during a routine prenatal visit.

Billing Considerations

Coders must ensure that the absence of hypertension is clearly documented to avoid misclassification.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal and fetal assessments, including ultrasound findings and laboratory results.

Common Clinical Scenarios

A high-risk pregnancy where the patient exhibits gestational edema and proteinuria, requiring close monitoring.

Billing Considerations

High-risk factors must be documented to justify the complexity of care and coding.

Coding Guidelines

Inclusion Criteria

Use O12.2 When
  • According to ICD
  • 10 coding guidelines, O12
  • 2 should be used when a patient presents with gestational edema and proteinuria without hypertension
  • Coders must ensure that the clinical documentation supports the diagnosis and that the absence of hypertension is clearly stated

Exclusion Criteria

Do NOT use O12.2 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81000CPT Code

Urinalysis, by dipstick or tablet reagent

Clinical Scenario

Used during routine prenatal visits to check for proteinuria.

Documentation Requirements

Document the results of the urinalysis and any follow-up actions taken.

Specialty Considerations

Ensure that the urinalysis is linked to the diagnosis of gestational edema.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including gestational edema with proteinuria. This specificity aids in better tracking and management of maternal health during pregnancy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including gestational edema with proteinuria. This specificity aids in better tracking and management of maternal health during pregnancy.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including gestational edema with proteinuria. This specificity aids in better tracking and management of maternal health during pregnancy.

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 significance of proteinuria in gestational edema?

Proteinuria in gestational edema can indicate kidney stress and requires monitoring to prevent complications. It is essential to differentiate this condition from preeclampsia, which involves hypertension.