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ICD-10 Guide
ICD-10 CodesO12.22

O12.22

Billable

Gestational edema with proteinuria, second trimester

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

Code Description

ICD-10 O12.22 is a billable code used to indicate a diagnosis of gestational edema with proteinuria, second trimester.

Key Diagnostic Point:

Gestational edema with proteinuria in the second trimester refers to the accumulation of excess fluid in the tissues of a pregnant woman, accompanied by the presence of protein in the urine, occurring between the 14th and 27th weeks of gestation. This condition is significant as it may indicate underlying issues related to kidney function or the body's ability to manage fluid balance during pregnancy. Unlike gestational hypertension or preeclampsia, this condition occurs without elevated blood pressure. Clinically, gestational edema can manifest as swelling in the legs, feet, and hands, while proteinuria is typically assessed through urine tests. The presence of protein in the urine can be a marker for potential complications, necessitating careful monitoring and management. It is essential for healthcare providers to differentiate this condition from other hypertensive disorders of pregnancy to ensure appropriate care and intervention. Regular prenatal visits and urine analysis are crucial for early detection and management of gestational edema with proteinuria, ensuring the health of both the mother and the fetus.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other hypertensive disorders of pregnancy
  • Need for accurate urine protein quantification
  • Monitoring for potential progression to preeclampsia
  • Documentation of gestational age and clinical findings

Audit Risk Factors

  • Inadequate documentation of urine protein levels
  • Failure to note gestational age accurately
  • Misclassification of edema severity
  • Lack of follow-up documentation for monitoring

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Detailed prenatal visit notes including urine test results, edema assessment, and maternal health status.

Common Clinical Scenarios

Routine prenatal visits where proteinuria is detected, management of mild edema, and monitoring for signs of preeclampsia.

Billing Considerations

Ensure clear documentation of the absence of hypertension and other related symptoms to avoid misdiagnosis.

Maternal-Fetal Medicine

Documentation Requirements

Comprehensive records of maternal and fetal assessments, including ultrasound findings and laboratory results.

Common Clinical Scenarios

Management of high-risk pregnancies 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 O12.22 When
  • Follow the official ICD
  • CM coding guidelines for obstetric conditions, ensuring that the gestational age is documented and that the absence of hypertension is clearly stated
  • Use additional codes for any related conditions or complications as necessary

Exclusion Criteria

Do NOT use O12.22 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 prenatal visits.

Documentation Requirements

Document the reason for urinalysis and results clearly.

Specialty Considerations

Ensure that the urinalysis is linked to the assessment of gestational edema.

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 treatment plans. O12.22 provides a clear distinction between gestational edema with and without proteinuria, enhancing clinical 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 treatment plans. O12.22 provides a clear distinction between gestational edema with and without proteinuria, enhancing clinical management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, improving the accuracy of diagnoses and treatment plans. O12.22 provides a clear distinction between gestational edema with and without proteinuria, enhancing clinical 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 gestational edema?

Proteinuria in gestational edema can indicate potential complications, such as the risk of developing preeclampsia. It is crucial to monitor protein levels to ensure maternal and fetal health.