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ICD-10 Guide
ICD-10 CodesChapter 15: Pregnancy, childbirth and the puerperiumO12

O12

Billable

Gestational [pregnancy-induced] edema and proteinuria without hypertension

Chapter 15:Pregnancy, childbirth and the puerperium

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

Code Description

ICD-10 O12 is a billable code used to indicate a diagnosis of gestational [pregnancy-induced] edema and proteinuria without hypertension.

Key Diagnostic Point:

Gestational edema and proteinuria without hypertension is a condition that occurs during pregnancy, characterized by the accumulation of excess fluid in the body's tissues (edema) and the presence of protein in the urine (proteinuria) without the elevation of blood pressure that typically accompanies preeclampsia. This condition can arise due to physiological changes during pregnancy, including increased blood volume and changes in kidney function. It is important to monitor these symptoms closely, as they can indicate underlying issues that may affect maternal and fetal health. While gestational edema is common, the presence of proteinuria necessitates careful evaluation to rule out more serious conditions. Management typically involves monitoring, lifestyle modifications, and in some cases, medication to alleviate symptoms and ensure the health of both mother and baby.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational edema and other types of edema.
  • Identifying the presence of proteinuria and its clinical significance.
  • Monitoring for progression to more severe conditions like preeclampsia.
  • Understanding the implications of gestational conditions on maternal and fetal health.

Audit Risk Factors

  • Inadequate documentation of symptoms leading to misclassification.
  • Failure to monitor and document changes in patient condition.
  • Incorrect coding due to confusion with other hypertensive disorders.
  • Lack of follow-up documentation on proteinuria and edema.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed notes on edema and proteinuria, including lab results and patient history.

Common Clinical Scenarios

A pregnant patient presenting with swelling in the lower extremities and proteinuria during routine prenatal visits.

Billing Considerations

Ensure clear differentiation from preeclampsia and other hypertensive disorders.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of maternal and fetal assessments, including ultrasound findings and lab tests.

Common Clinical Scenarios

Management of a high-risk pregnancy with gestational edema and proteinuria requiring close monitoring.

Billing Considerations

Focus on the potential for progression to more severe conditions and the need for multidisciplinary care.

Coding Guidelines

Inclusion Criteria

Use O12 When
  • Follow the official ICD
  • CM guidelines for obstetric coding, ensuring that the diagnosis is supported by clinical documentation and that the condition is clearly defined as gestational without hypertension

Exclusion Criteria

Do NOT use O12 When
No specific exclusions found.

Related CPT Codes

81002CPT Code

Urinalysis, automated, with microscopy

Clinical Scenario

Used to evaluate proteinuria in pregnant patients.

Documentation Requirements

Document the reason for urinalysis and results clearly.

Specialty Considerations

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 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 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 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 significance of proteinuria in pregnancy?

Proteinuria can indicate kidney stress or damage and is a key marker in diagnosing conditions like preeclampsia. In the absence of hypertension, it may still require monitoring to ensure maternal and fetal health.