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ICD-10 Guide
ICD-10 CodesO12.23

O12.23

Billable

Gestational edema with proteinuria, third trimester

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

Code Description

ICD-10 O12.23 is a billable code used to indicate a diagnosis of gestational edema with proteinuria, third trimester.

Key Diagnostic Point:

Gestational edema with proteinuria in the third trimester is a condition characterized by the accumulation of excess fluid in the tissues, leading to swelling, particularly in the lower extremities, and the presence of protein in the urine. This condition typically arises during the later stages of pregnancy and is often associated with physiological changes that occur as the body adapts to support the growing fetus. While edema can be a normal part of pregnancy, the presence of proteinuria indicates a potential complication that requires careful monitoring. It is crucial to differentiate this condition from gestational hypertension or preeclampsia, as the absence of hypertension is a key factor in this diagnosis. Management may involve lifestyle modifications, monitoring of symptoms, and regular follow-up to ensure the health of both the mother and the fetus. Accurate coding of this condition is essential for appropriate clinical management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other hypertensive disorders of pregnancy.
  • Need for precise documentation of proteinuria levels.
  • Monitoring and management protocols that vary by provider.
  • Potential overlap with other conditions such as gestational hypertension.

Audit Risk Factors

  • Inadequate documentation of proteinuria levels.
  • Failure to document the absence of hypertension.
  • Misclassification of edema as a symptom of another condition.
  • Inconsistent follow-up notes regarding the patient's condition.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include detailed notes on edema severity, proteinuria test results, and absence of hypertension.

Common Clinical Scenarios

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

Billing Considerations

Consideration of the patient's overall health, previous pregnancy history, and any comorbid conditions.

Maternal-Fetal Medicine

Documentation Requirements

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

Common Clinical Scenarios

High-risk pregnancies where monitoring for complications is critical.

Billing Considerations

In-depth evaluation of potential risks associated with gestational edema and proteinuria.

Coding Guidelines

Inclusion Criteria

Use O12.23 When
  • According to ICD
  • 10 guidelines, accurate coding of O12
  • 23 requires documentation of the gestational age, specific symptoms, and laboratory findings
  • It is essential to ensure that the diagnosis is supported by clinical evidence and that it is distinct from other hypertensive disorders

Exclusion Criteria

Do NOT use O12.23 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 indicating proteinuria.

Specialty Considerations

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like O12.23, improving the accuracy of diagnoses and facilitating better patient management and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like O12.23, improving the accuracy of diagnoses and facilitating better patient management and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 indicates potential kidney involvement and may signal the need for further evaluation to rule out conditions like preeclampsia. It is essential to monitor protein levels and manage the condition appropriately to ensure maternal and fetal health.