Cardiology Coding Alert

ICD-9 2010 brings a huge expansion in thrombosis and embolism coding options, which means you need a keen eye to spot precise anatomic locations and whether a problem is chronic or acute.

Dig into these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1. Then turn to page 95 for the answers.

For services Oct. 1, 2009, or later, which ICD-9 code should you choose if your documentation indicates the following?

• Male patient, 69, complains of chronic swelling and pain in his left leg. Comprehensive history and exam performed.

• Ordered CBC, Chem panel, D-dimer, and Doppler ultrasound of leg ... Ultrasound indicates significant iliofemoral chronic venous thrombosis.

• Initiation of Heparin therapy to prevent worsening and hospital admission.

• Patient had proximal thrombosis, same leg, Aug. 2008.

A. 453.41 -- Venous embolism and thrombosis of deep vessels of proximal lower extremity

B. 453.41 -- Acute venous embolism and thrombosis of deep vessels of proximal lower extremity

C. 453.51 -- Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity

For services Oct. 1, 2009, or later, which ICD-9 code should you choose if your documentation indicates the following?

Patient presents with pain and swelling in his left arm; he also reports vague shoulder and neck pain. The exam reveals low-grade fever, mild cyanosis of the left arm, and elevated jugular venous distention. The cardiologist diagnoses an acute cephalic vein embolism and orders catheter-directed anticoagulant therapy.

A. 453.8 -- Other venous embolism and thrombosis; of other specified veins

B. 453.81 -- Acute venous embolism and thrombosis of superficial veins of upper extremity

C. 453.82 -- Acute venous embolism and thrombosis of deep veins of upper extremity

The cardiologist works up a patient with secondary pulmonary hypertension (416.8, Other chronic pulmonary heart diseases) and finds a pre-existing, undissolved clot in one of the pulmonary arteries. For services Oct. 1, 2009, or later, which code describes this clot?

A. 415.19 -- Pulmonary embolism and infarction; other

B. 416.2 -- Chronic pulmonary embolism

C. V12.51 -- Personal history of certain other diseases; venous thrombosis and embolism.