Wiki Peripheral Arterial Disease Coding – Lower Limb Thrombosis

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dchen

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Hello All,

When trying to appropriately code for patients that have been deemed as having a subacute lower limb arterial thrombus (patients with onset symptoms of greater than 14 days but less than 6 months) that will need to be treated by mechanical arterial thrombectomy, how would one code for this? I see there is an ICD-10 code of I74.3 (Embolism and thrombosis of arteries of the lower extremities) but this does not indicate if the patient is deemed as being acute, subacute, or chronic. If there is not a specified code, would there be a combination of codes that could easily determine the classification of the disease state? The goal is to try to identify this patient population for a retrospective clinical study using de-identified data where I will not have access to medical records that indicate the severity of the patient.

Any guidance with this is very appreciated!
 
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Don't think that the course can be further specified for that particular condition.

To note, such specificity is possible in ICD-11 via extension codes:
  • XT5R Acute
  • XT1L Subacute
  • XT8W Chronic
 
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Hi Dchen
You can always take any CPT code then see which dx code it links too under the CMS website. I hope this data helps you and the provider. Some dx seem to fit this category of treatment range in dx blocks of I82.4, Z86.718 C47-C49,or I70
Lady T
 
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TThivierge said:
Hi Dchen
You can always take any CPT code then see which dx code it links too under the CMS website. I hope this data helps you and the provider. Some dx seem to fit this category of treatment range in dx blocks of I82.4, Z86.718 C47-C49,or I70
Lady T
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Could you explain how to do that on CMS?
 
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TThivierge said:
Hi XXXPAragon
To read more about the MPFS search tool, go to the MLN® booklet, How to Use The Searchable Medicare Physician Fee Schedule Booklet (PDF) . See reference
https://www.cms.gov/medicare/payment/fee-schedules/physician/lookup-tool. You put in CPT code and list dx associated with medical necessity coverage. Alos most medical speciate
newsletter online will list data on billing regarding gastro,orthopediacs, OB/GYN, Etc. That can help you too
I hope helped you
Lady T
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Hmmm, I'm familiar with the tool. I re-read through the PDF and went back to the tool, but I still don't see where it provides a list of all the ICD-10 diagnoses that support the medical necessity of the CPT/HCPCS code. Maybe I am lost, but I don't see it.
 
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TThivierge said:
Hi Dchen
You can always take any CPT code then see which dx code it links too under the CMS website. I hope this data helps you and the provider. Some dx seem to fit this category of treatment range in dx blocks of I82.4, Z86.718 C47-C49,or I70
Lady T
Click to expand...
Thank you for this information. I appreciate the insight! However, when I checked the tool, I do not see the Dx list associated with the CPT code that I am looking for. Is there another area that I should be looking at? The tool itself gives me all the fee schedule information, as expected, but not a medical necessity guide. Any additional guidance would be appreciated.
 
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xXxPARAGONxXx said:
Hmmm, I'm familiar with the tool. I re-read through the PDF and went back to the tool, but I still don't see where it provides a list of all the ICD-10 diagnoses that support the medical necessity of the CPT/HCPCS code. Maybe I am lost, but I don't see it.
Click to expand...
I am familiar with the tool as well and have searched through it and do not see the Dx linkage, so you are not alone.
 
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See page 38 of the March 2024 issue of AAPC Business Monthly which you can download: Acute Pulmonary Embolism. DVT cam be acute or chronic. An acute DVT is typically less than 2 weeks old. Subacute DVT is more than 2 weeks old and less than 6 weeks. A chronic DVT is more than 6 months old. Does that help with your question?
 
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praseedah@gmail.com said:
See page 38 of the March 2024 issue of AAPC Business Monthly which you can download: Acute Pulmonary Embolism. DVT cam be acute or chronic. An acute DVT is typically less than 2 weeks old. Subacute DVT is more than 2 weeks old and less than 6 weeks. A chronic DVT is more than 6 months old. Does that help with your question?
Click to expand...
Thank you for the reference. That is what I came to conclude as well. The issue is being able to have a specific Dx code that would differentiate the stages. In terms of DVT vs. arterial thrombectomy, DVTs have specific "acute" and "chronic" ICD-10 codes, but arterial does not to my knowledge.
 
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