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Thread: Ischemic rest pain lower extremity

  1. #1
    Join Date
    Apr 2007
    Greeley, Colorado

    Question Ischemic rest pain lower extremity

    AAPC: Back to School
    Does this code to 440.22 or 440.24? No mention of ulcer. This confuses me
    Lisa Bledsoe, CPC, CPMA

  2. #2


    The two typical symptoms of PAD are intermittent claudication and ischemic rest pain.

    1. Intermittent claudication occurs during exercise when the vascular flow or supply doesn't meet the increased demand for blood flow to the leg muscles. Patients with true claudication may also have decreased or absent peripheral pulses and arterial ulcerations involving the toes or feet.

    2. Ischemic rest pain occurs while the person is resting in a supine position. Often, the symptoms are most severe in the toes and feet. Patients will find relief by dangling their feet or placing them in a slightly dependent position to augment the limited blood flow to the area.
    So when it is clearly documented as Ischaemic rest pain, I would prefer to give 440.22.
    So any condition referring to PAD with these symptoms could be included onto 440.22,unless thereis only mention of intermittetant claudication which has its own specificity440.21.
    Yes as you say it is a sort of confused note there!
    But 440.24 to be reported there should be Gangrene_ a black dying ulcerated wound there
    Thank you
    Last edited by preserene; 05-21-2011 at 12:54 PM.

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