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ICD-10 Guide
ICD-10 CodesO12.21

O12.21

Billable

Gestational edema with proteinuria, first trimester

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

Code Description

ICD-10 O12.21 is a billable code used to indicate a diagnosis of gestational edema with proteinuria, first trimester.

Key Diagnostic Point:

Gestational edema with proteinuria in the first trimester refers to the presence of swelling due to fluid retention and protein in the urine during the early stages of pregnancy. This condition can arise as a result of physiological changes in the body, including increased blood volume and hormonal fluctuations. While edema is common in pregnancy, the presence of proteinuria may indicate an underlying issue that requires monitoring. It is crucial to differentiate this condition from gestational hypertension or preeclampsia, which are characterized by elevated blood pressure. The management of gestational edema with proteinuria typically involves monitoring the patient's symptoms, dietary modifications, and ensuring adequate hydration. Regular follow-up is essential to assess the progression of the condition and to rule out any complications. Early identification and appropriate management can help mitigate risks to both the mother and the fetus.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other edema-related conditions
  • Need for accurate assessment of protein levels in urine
  • Monitoring for potential progression to hypertension or preeclampsia
  • Documentation of gestational age and trimester

Audit Risk Factors

  • Inadequate documentation of proteinuria testing
  • Failure to note the absence of hypertension
  • Misclassification of edema type
  • Lack of follow-up notes on patient condition

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation should include detailed notes on edema assessment, proteinuria test results, and any interventions or follow-ups.

Common Clinical Scenarios

Patients presenting with swelling in the extremities and proteinuria during routine prenatal visits.

Billing Considerations

Ensure that the absence of hypertension is clearly documented to avoid misclassification.

Maternal-Fetal Medicine

Documentation Requirements

High-risk pregnancy documentation should include comprehensive assessments of maternal and fetal health, including any signs of progression to preeclampsia.

Common Clinical Scenarios

Management of patients with a history of gestational hypertension or preeclampsia in previous pregnancies.

Billing Considerations

Close monitoring of protein levels and maternal symptoms is critical in high-risk cases.

Coding Guidelines

Inclusion Criteria

Use O12.21 When
  • According to the official ICD
  • 10 coding guidelines, accurate coding for gestational conditions requires documentation of the trimester, specific symptoms, and any associated conditions
  • It is essential to follow the guidelines for coding pregnancy
  • related complications to ensure proper reimbursement and care continuity

Exclusion Criteria

Do NOT use O12.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

81002CPT Code

Urinalysis, automated, with microscopy

Clinical Scenario

Used to assess protein levels in urine during routine prenatal visits.

Documentation Requirements

Document the reason for urinalysis and results, including protein levels.

Specialty Considerations

Ensure that the urinalysis is performed in accordance with obstetric guidelines.

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, improving the accuracy of diagnoses and facilitating better patient care. O12.21 provides a clear distinction for gestational edema with proteinuria, enhancing clinical understanding and management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the accuracy of diagnoses and facilitating better patient care. O12.21 provides a clear distinction for gestational edema with proteinuria, enhancing clinical understanding and management.

Reimbursement & Billing Impact

reimbursement.

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 potential complications, such as the risk of developing gestational hypertension or preeclampsia. It is crucial to monitor protein levels and assess the patient's overall condition to ensure maternal and fetal health.