Neurosurgery Coding Alert

Published on Tue Feb 02, 2016 PDF

Question: A patient who was hospitalized for a neurosurgical procedure and had no history of pulmonary embolism, developed pulmonary embolism. What diagnosis code can we submit for pulmonary embolism developing as a complication of surgical care?

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Answer: Pulmonary embolism is a rare but known complication of surgical care when the patient is confined to bed during the post-operative period or has a pre-operative motor deficit, particularly of a lower limb. For pulmonary embolism during surgical care, you will use codes from the following families of ICD-10 codes:

• T81.7- (Vascular complications following a procedure, not elsewhere classified), or
• T82.8- (Other specified complications of cardiac and vascular prosthetic devices, implants and grafts)

Pulmonary embolism may develop as a consequence to an infusion or transfusion. In this case, you submit ICD-10 code T80.0 (Air embolism following infusion, transfusion and therapeutic injection).

Report the personal history only if present: Use the Z code Z86.711 (Personal history of pulmonary embolism) when there is only a history of a pulmonary embolism, and it is no longer present and not relevant to the reason for a current evaluation.