Two Criteria Determine DVT and Venous Emboli Dx
By Sara Wolf, BA, CPC-H, CCS, and G. J. Verhovshek, MA, CPC
Deep vein thrombosis or deep venous thrombosis (DVT) describes the formation of a blood clot (thrombus) in a “deep” vein. The condition is most common in the large veins of the lower extremities (for example, the femoral vein), but may occur in veins of the upper extremities, as well.
DVT may be asymptomatic, but more frequently exhibits symptoms of pain, swelling, and discoloration in the affected extremity. Three broad mechanisms—called “Virchow’s triad” in honor of German physician Rudolf Virchow—are the primary causes of DVT:
1. Decreased blood flow
2. Damage to the wall of the vein
3. Increased blood clotting (hypercoagulability)
Many specific circumstances may contribute to the formation of DVT. Recent surgery—especially hip, pelvic, or prostate surgery—is a risk factor (See “DVT Linked to Surgery Calls for Unique Coding” for more information.), as is inactivity, obesity, smoking, a history of cardiovascular disease, or other medical conditions ranging from cancer to bone fracture. Women who are pregnant or who have been pregnant recently are more prone to DVT, as are those who use estrogen or oral contraceptives.
Verify Criteria to Determine Codes
ICD-9-CM groups DVT by two criteria: vein location and chronic vs. acute. The determination of chronic vs. acute must be made by the documenting provider, based on the clinical evidence. For example, the diameter of a vein as measured by duplex scan may increase in acute conditions, but will decrease to less than normal over time.
Chronic vs. Acute: Make the Distinction
Here are the acute and chronic DVT codes for upper and lower extremities:
DVT Lower Extremities
- Acute: femoral, iliac, popliteal, and vein of thigh or upper leg not otherwise specified (453.41 Acute venous embolism and thrombosis of deep vessels of proximal lower extremity)
- Acute: peroneal, tibial, and vein of calf or lower leg not otherwise specified (453.42 Acute venous embolism and thrombosis of deep vessels of distal lower extremity)
- Acute: unspecified vein of lower extremity and DVT not otherwise specified (453.40 Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity)
- Chronic: femoral, iliac, popliteal, and vein of thigh or upper leg not otherwise specified (453.51 Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity)
- Chronic: peroneal, tibial, and vein of calf or lower leg not otherwise specified (453.52 Chronic venous embolism and thrombosis of deep vessels of distal lower extremity)
- Chronic: unspecified vein of lower extremity (453.50 Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity)
DVT Upper Extremities
- Acute: brachial, radial, and ulnar vein (453.82 Acute venous embolism and thrombosis of deep veins of upper extremity)
- Chronic: brachial, radial, and ulnar vein (453.72 Chronic venous embolism and thrombosis of deep veins of upper extremity)
Note that the default code for DVT of an unspecified site is 453.40. ICD-9-CM also contains codes to report embolism/thrombosis of superficial and/or other specified (not deep) veins (e.g., 453.6 Venous embolism and thrombosis of superficial vessels of lower extremity and 453.76 Chronic venous embolism and thrombosis of internal jugular veins).
The distinction between acute and chronic is important because patients with DVT may require anticoagulant therapy for six months or more; an acute diagnosis would support initiation of such therapy, while a chronic diagnosis would support its continuation. Code V58.61 Long term (current) use of anticoagulants may be reported in addition to the code describing the DVT if the patient currently is undergoing anticoagulant therapy.
If a patient has a history of venous thrombosis that is no longer present, you may assign personal history code V12.51 Personal history of venous thrombosis and embolism, pulmonary embolism.
PE Complicates DVT and Coding
An embolism occurs when a thrombus dislodges and is carried by the circulatory system to a different part of the body. The clot travels through progressively smaller vessels until it becomes stuck in place. An embolism resulting from DVT most often affects vessels of the lungs after traveling through the heart. This is called a pulmonary embolism (PE), and it may result in labored breathing, chest pains, and even death.
An acute PE may be reported from ICD-9-CM category 415.1x Pulmonary embolism and infarction. Note that septic pulmonary embolism code (415.12 Septic pulmonary embolism) requires you to sequence the underlying infection before the PE code. Chronic PE is reported using 416.2 Chronic pulmonary embolism.
Sara Wolf, BA, CPC-H, CCS, has nearly 30 years of coding experience. She is executive director for ZHealth, providing coding consulting and reimbursement evaluation for facility and physician services.
G.J. Verhovshek, MA, CPC, is managing editor at AAPC.