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ICD-10 Guide
ICD-10 CodesO12.00

O12.00

Billable

Gestational edema, unspecified trimester

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

Code Description

ICD-10 O12.00 is a billable code used to indicate a diagnosis of gestational edema, unspecified trimester.

Key Diagnostic Point:

Gestational edema refers to the accumulation of excess fluid in the tissues during pregnancy, which can occur in any trimester. This condition is characterized by swelling, particularly in the lower extremities, and is often benign. It is important to differentiate gestational edema from other conditions such as preeclampsia, which involves hypertension and proteinuria. In cases of gestational edema without hypertension, the swelling is typically not associated with significant health risks for the mother or fetus. However, it can be uncomfortable and may require monitoring. The presence of proteinuria without hypertension may indicate a need for further evaluation to rule out underlying conditions. Proper documentation should include the extent of edema, any associated symptoms, and the absence of hypertension to ensure accurate coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between gestational edema and other hypertensive disorders of pregnancy.
  • Documenting the absence of hypertension and proteinuria accurately.
  • Understanding the implications of edema in different trimesters.
  • Navigating the coding guidelines for related conditions.

Audit Risk Factors

  • Inadequate documentation of the absence of hypertension.
  • Failure to specify the trimester of pregnancy.
  • Misclassification of edema as a more severe condition.
  • Lack of follow-up documentation regarding the management of edema.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include the patient's history, physical examination findings, and any relevant laboratory results, particularly regarding protein levels.

Common Clinical Scenarios

A patient presents with swelling in the legs during the third trimester without elevated blood pressure or proteinuria.

Billing Considerations

Coders should ensure that the edema is not confused with more serious conditions like preeclampsia.

Maternal-Fetal Medicine

Documentation Requirements

Detailed documentation of maternal and fetal health, including any risk factors for complications.

Common Clinical Scenarios

A high-risk patient with a history of gestational hypertension presents with new-onset edema.

Billing Considerations

Close monitoring and documentation of any changes in the patient's condition are crucial.

Coding Guidelines

Inclusion Criteria

Use O12.00 When
  • Coders should refer to the official ICD
  • CM guidelines for obstetric coding, ensuring that the diagnosis is supported by clinical documentation and that the appropriate trimester is indicated

Exclusion Criteria

Do NOT use O12.00 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 for patients with gestational edema.

Documentation Requirements

Document the patient's symptoms, vital signs, and any relevant lab results.

Specialty Considerations

Obstetricians should ensure that the visit is clearly related to the management of edema.

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 should be documented to support the diagnosis of O12.00?

Documentation should include the patient's symptoms, the absence of hypertension, and any relevant lab results, particularly regarding protein levels.