ICD-10 O12.13
Billable / Specific CCGestational proteinuria, third trimester
About ICD-10-CM O12.13
ICD-10-CM code O12.13 represents Gestational proteinuria, third trimester. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O12). The 2026 edition of ICD-10-CM O12.13 became effective on October 1, 2025.
Coding Tips for O12.13
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O12.13 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Inpatient DRG Impact, CC
codes Gestational proteinuria, third trimester. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for O12.13
Local Coverage Determinations (LCDs) from CMS MACs that list O12.13 as a covered diagnosis.
Showing top 2. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O12.13.
1 Cigna
2 Medicare
CPT Codes Commonly Billed with O12.13
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 82610 CMS LCD: Billing and Coding: Lab: Cystatin C Measurement CMS LCD
Convert O12.13 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| O12.13 | 64621 | 10000 |
| O12.13 | 64623 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O12.13
Other codes in section O10-O16 (Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium).
ICD-10 O12.13, Billing FAQ
Is ICD-10 code O12.13 billable? +
Yes, O12.13 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is O12.13 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with O12.13? +
Procedures frequently paired with O12.13 include: 82610.
What ICD-9 codes does O12.13 map to? +
Per CMS GEMs, O12.13 maps to ICD-9 codes: 64621, 64623. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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