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ICD-10 Guide
ICD-10 CodesO12.20

O12.20

Billable

Gestational edema with proteinuria, unspecified trimester

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

Code Description

ICD-10 O12.20 is a billable code used to indicate a diagnosis of gestational edema with proteinuria, unspecified trimester.

Key Diagnostic Point:

Gestational edema with proteinuria, unspecified trimester, refers to the accumulation of excess fluid in the tissues of a pregnant woman, accompanied by the presence of protein in the urine. This condition typically arises during pregnancy and can be indicative of underlying issues, although it is not associated with hypertension in this specific code. Gestational edema can occur at any stage of pregnancy and may be a normal physiological response to the increased blood volume and fluid retention that occurs during this time. However, when proteinuria is present, it raises concerns for potential complications, such as gestational hypertension or preeclampsia, even if hypertension is not currently diagnosed. Accurate identification and coding of this condition are crucial for monitoring maternal and fetal health, as well as for appropriate management and intervention strategies. Clinicians must carefully document the presence of edema and proteinuria, including the timing of onset and any associated symptoms, to ensure proper coding and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between normal pregnancy-related edema and pathological edema.
  • Identifying the presence of proteinuria and its clinical significance.
  • Determining the trimester of pregnancy when the condition is diagnosed.
  • Understanding the implications of proteinuria without hypertension.

Audit Risk Factors

  • Inadequate documentation of the onset and duration of edema.
  • Failure to document the presence and significance of proteinuria.
  • Misclassification of the trimester of pregnancy.
  • Lack of follow-up documentation regarding the management of the condition.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed documentation of symptoms, timing, and clinical findings related to edema and proteinuria.

Common Clinical Scenarios

Routine prenatal visits where edema is noted, and urine tests reveal proteinuria.

Billing Considerations

Consideration of the patient's overall health, history of hypertension, and any other comorbidities.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive documentation of high-risk factors, including maternal history and fetal monitoring.

Common Clinical Scenarios

Management of patients with multiple risk factors for preeclampsia or other complications.

Billing Considerations

In-depth evaluation of maternal and fetal health, with a focus on potential complications.

Coding Guidelines

Inclusion Criteria

Use O12.20 When
  • According to official coding guidelines, O12
  • 20 should be used when gestational edema with proteinuria is documented without hypertension
  • Coders must ensure that the documentation supports the diagnosis and that the condition is not attributed to other causes

Exclusion Criteria

Do NOT use O12.20 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81002CPT Code

Urinalysis, automated, with microscopy

Clinical Scenario

Used to evaluate proteinuria in pregnant patients presenting with edema.

Documentation Requirements

Documentation of urinalysis results and clinical findings related to edema.

Specialty Considerations

Obstetricians should ensure that urinalysis is performed in conjunction with 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 obstetric conditions, including gestational edema with proteinuria. This specificity aids 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 aids 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 aids 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 should be documented to support the use of O12.20?

To support the use of O12.20, documentation should include the presence of edema, results of urine tests indicating proteinuria, and the absence of hypertension. Additionally, any relevant clinical findings and management plans should be clearly recorded.