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ICD-10 Guide
ICD-10 CodesO14.9

O14.9

Billable

Unspecified pre-eclampsia

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

Code Description

ICD-10 O14.9 is a billable code used to indicate a diagnosis of unspecified pre-eclampsia.

Key Diagnostic Point:

Unspecified pre-eclampsia is a hypertensive disorder of pregnancy characterized by the onset of hypertension and proteinuria after 20 weeks of gestation. It is a significant condition that can lead to severe maternal and fetal complications if not properly managed. Pre-eclampsia can present with various symptoms, including headaches, visual disturbances, and upper abdominal pain. The condition is often diagnosed through routine prenatal screenings that measure blood pressure and protein levels in urine. While the exact etiology remains unclear, factors such as obesity, advanced maternal age, and a history of pre-eclampsia can increase the risk. Management typically involves close monitoring, lifestyle modifications, and in some cases, the administration of magnesium sulfate to prevent seizures. The condition can progress to severe pre-eclampsia or HELLP syndrome, which requires immediate medical intervention. Accurate coding is essential for appropriate treatment and reimbursement, making it crucial for coders to understand the nuances of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of symptoms.
  • Differentiation between pre-eclampsia and other hypertensive disorders.
  • Need for precise documentation of maternal and fetal monitoring.
  • Potential for progression to severe pre-eclampsia or HELLP syndrome.

Audit Risk Factors

  • Inadequate documentation of blood pressure readings.
  • Failure to document the presence of proteinuria.
  • Misclassification of pre-eclampsia severity.
  • Lack of detailed treatment protocols, including magnesium sulfate administration.

Specialty Focus

Medical Specialties

Obstetrics and Gynecology

Documentation Requirements

Documentation must include blood pressure readings, proteinuria results, and any symptoms experienced by the patient.

Common Clinical Scenarios

Routine prenatal visits where hypertension is detected, or a patient presents with symptoms suggestive of pre-eclampsia.

Billing Considerations

Coders should be aware of the potential for progression to severe pre-eclampsia and ensure that documentation reflects the patient's condition accurately.

Maternal-Fetal Medicine

Documentation Requirements

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

Common Clinical Scenarios

Management of high-risk pregnancies where pre-eclampsia is diagnosed or suspected.

Billing Considerations

High-risk patients may require more intensive monitoring and intervention, necessitating thorough documentation for coding.

Coding Guidelines

Inclusion Criteria

Use O14.9 When
  • Coders should follow the official ICD
  • CM guidelines for obstetric coding, ensuring that all relevant clinical information is documented
  • Specific criteria for diagnosing pre
  • eclampsia include elevated blood pressure readings and the presence of proteinuria after 20 weeks of gestation

Exclusion Criteria

Do NOT use O14.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, level 3

Clinical Scenario

Used during routine prenatal visits for monitoring pre-eclampsia.

Documentation Requirements

Documentation must include blood pressure readings and any symptoms reported by the patient.

Specialty Considerations

Obstetricians should ensure that all relevant clinical information is captured to support the visit level.

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 pre-eclampsia. This specificity aids in better tracking of maternal and fetal outcomes and enhances the ability to analyze healthcare data related to pregnancy complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including pre-eclampsia. This specificity aids in better tracking of maternal and fetal outcomes and enhances the ability to analyze healthcare data related to pregnancy complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of obstetric conditions, including pre-eclampsia. This specificity aids in better tracking of maternal and fetal outcomes and enhances the ability to analyze healthcare data related to pregnancy complications.

Resources

Clinical References

  • •
    ACOG Practice Bulletin on Hypertension in Pregnancy

Coding & Billing References

  • •
    ACOG Practice Bulletin on Hypertension in Pregnancy

Frequently Asked Questions

What are the key symptoms of pre-eclampsia that should be documented?

Key symptoms include elevated blood pressure, proteinuria, headaches, visual disturbances, and upper abdominal pain. Accurate documentation of these symptoms is crucial for proper coding and management.