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ICD-10 Guide
ICD-10 CodesO12.25

O12.25

Billable

Gestational edema with proteinuria, complicating the puerperium

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

Code Description

ICD-10 O12.25 is a billable code used to indicate a diagnosis of gestational edema with proteinuria, complicating the puerperium.

Key Diagnostic Point:

Gestational edema with proteinuria is a condition that occurs during pregnancy characterized by the accumulation of excess fluid in the body's tissues, leading to swelling, particularly in the legs and feet. This condition can be accompanied by proteinuria, which is the presence of excess protein in the urine, indicating potential kidney involvement. In the context of the puerperium, which is the period following childbirth, the presence of gestational edema and proteinuria can complicate recovery and may indicate underlying health issues that need to be monitored. It is essential for healthcare providers to assess the severity of edema and proteinuria, as these symptoms can be indicative of more serious conditions such as preeclampsia or eclampsia, even in the absence of hypertension. Proper management includes monitoring fluid intake, dietary adjustments, and possibly medication to manage symptoms and prevent complications. Documentation should include the onset, duration, and severity of symptoms, as well as any interventions taken during the puerperium.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational edema and other types of edema.
  • Identifying the presence of proteinuria without hypertension.
  • Understanding the implications of edema and proteinuria in the postpartum period.
  • Documenting the clinical significance of findings accurately.

Audit Risk Factors

  • Inadequate documentation of symptoms and their severity.
  • Failure to differentiate between gestational and chronic conditions.
  • Misinterpretation of proteinuria levels.
  • Inconsistent coding of related conditions.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of maternal symptoms, laboratory results for proteinuria, and any interventions or treatments provided during the puerperium.

Common Clinical Scenarios

A patient presenting with significant swelling and proteinuria after delivery, requiring monitoring for potential complications.

Billing Considerations

Coders must ensure that the condition is not confused with other hypertensive disorders of pregnancy.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of maternal-fetal interactions, risk assessments, and management plans for high-risk patients.

Common Clinical Scenarios

High-risk patients with a history of gestational hypertension or preeclampsia presenting with edema and proteinuria.

Billing Considerations

Special attention to the management of patients with a history of complications in previous pregnancies.

Coding Guidelines

Inclusion Criteria

Use O12.25 When
  • According to ICD
  • 10 coding guidelines, O12
  • 25 should be used when gestational edema is accompanied by proteinuria without hypertension
  • Coders must ensure that the condition is documented clearly in the medical record to support the use of this specific code

Exclusion Criteria

Do NOT use O12.25 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits to monitor edema and proteinuria in postpartum patients.

Documentation Requirements

Documentation must include assessment of symptoms, urine tests, and any interventions.

Specialty Considerations

Obstetricians should ensure that the visit is clearly linked to the management of postpartum complications.

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 helps in better tracking of maternal health outcomes and resource allocation in obstetric care.

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 helps in better tracking of maternal health outcomes and resource allocation in obstetric care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including gestational edema with proteinuria. This specificity helps in better tracking of maternal health outcomes and resource allocation in obstetric care.

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 coding O12.25?

Coding O12.25 accurately reflects the presence of gestational edema and proteinuria in the postpartum period, which is crucial for monitoring maternal health and preventing complications.