O12.25 ICD-10-CM Code: Gestational edema with proteinuria, complicating the puerperium
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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (O10-O16)
O12.25
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGestational edema with proteinuria, complicating the puerperium
Swelling and protein in the urine occurring in the postpartum period (after delivery) in a patient with gestational edema and proteinuria.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 209
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for O12.25 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for O12.25 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for O12.25 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for O12.25 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for O12.25 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for O12.25 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for O12.25 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is O12.25 an HCC code?
No. O12.25 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- O12.25
- Description
- Gestational edema with proteinuria, complicating the puerperium
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O12.25 is the ICD-10-CM diagnosis code for gestational edema with proteinuria, complicating the puerperium. Swelling and protein in the urine occurring in the postpartum period (after delivery) in a patient with gestational edema and proteinuria. O12.25 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering edema, proteinuria and hypertensive disorders in pregnancy, childbirth and the puerperium (o10-o16).
O12.25 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document that both edema and proteinuria persist or occur in the postpartum period.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O12.25 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document that both edema and proteinuria persist or occur in the postpartum period
- •The puerperium extends approximately 6 weeks after delivery