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Old 12-16-2008, 01:02 PM
jvargocpc jvargocpc is offline
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Question Elevated D-dimer ICD-9 code

We had a patient come in to our ER with lower leg pain. X-ray was negative, but D-dimer was elevated, so Ultrasound was ordered. Ultrasound was also negative. The only code I could come up with for the elevated D-dimer was 79099, Other Nonspecific Finding of Blood. Our claim scrubber doesn't like that, so I'm in search of another code for elevated D-dimer.

Any thoughts?
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Old 12-16-2008, 01:21 PM
pharmon pharmon is offline
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Wouldn't they be ok with just leg pain?
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Old 12-16-2008, 01:33 PM
jvargocpc jvargocpc is offline
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The claim scrubber is stating it won't be covered. Reason for visit was leg pain and principal diagnosis was leg and knee strain. That's why I'm trying to add the info about the elevated D-dimer. If I can't find any other code to use, I'll just send it through as is.

Just trying to add a little info!
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Old 12-16-2008, 02:09 PM
pharmon pharmon is offline
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I think I would do pain, and even tho 790.99 isn't paid, i'd use it as additional information to them.
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Old 12-16-2008, 03:29 PM
jvargocpc jvargocpc is offline
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Just a clarification - The problem that I'm running into isn't that they aren't paying for the D-dimer, they aren't paying for the lower extremity ultrasound. I'm trying to add additional info to prove that we needed to do it. That's why I'm asking if anyone has a better idea for a more specific code for the elevated D-dimer. The reason the lower extremity ultrasound was done, was because of the elevated D-dimer and a negative plain film of the leg.

Does that make sense?
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Old 12-16-2008, 09:10 PM
Mouf1818 Mouf1818 is offline
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we were always told to use 790.99 for elevated d-dimer...so you will have to bill with that and 729.5 and if they don't want to pay for it there is nothing more you can do about it, you did your job!!!

Amber, CPC
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Old 12-17-2008, 07:06 AM
Anna Weaver Anna Weaver is offline
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Default d-dimer

Since D-Dimer is a coagulation study profile, I use the 790.92 if it's abnormal and stated as such by the physician (elevated D-dimer). I know this is one of those controversial things, but this is what Labtestsoneline has to say about D-Dimer:

How is it used?
D-dimer tests are ordered, along with other laboratory tests and imaging scans, to help rule out, diagnose, and monitor diseases and conditions that cause hypercoagulability, a tendency to clot inappropriately. One of the most common of these conditions is DVT (Deep Vein Thrombosis), which involves clot formation in the deep veins of the body, most frequently in the legs. These clots may grow very large and block blood flow in the legs, causing swelling, pain, and tissue damage. It is possible for a piece of the clot to break off (this broken piece is called an embolus) and travel to other parts of the body, where the clot can cause a PE (Pulmonary embolus or embolism - blood clot in the lungs).
While clots most commonly form in the veins of the legs, they may also form in other areas as well; for example, clots in coronary arteries are the cause of myocardial infarction (heart attacks). Clots may also form on the lining of the heart or its valves, particularly when the heart is beating irregularly (atrial fibrillation) or when the valves are damaged. Clots also may form in large arteries as a result of damage from atherosclerosis (sometimes called hardening of the arteries). Pieces of such clots may also break off and cause an embolus that blocks an artery in another organ, such as the brain (causing a stroke) or the kidneys. Measurements of D-dimer can also be used to detect clots in these other sites.

Measurements of D-dimer may also be ordered, along with other tests, to help diagnose DIC (Disseminated Intravascular Coagulation). DIC is a complex acute condition that can arise from a variety of situations including: some surgical procedures, septic shock, poisonous snake bites, liver disease, and postpartum (after the delivery of a baby). With DIC, clotting factors are activated and then used up throughout the body. This creates numerous minute blood clots and at the same time leaves the patient vulnerable to excessive bleeding. Steps are taken to support the patient, while the underlying problem is addressed, and the underlying condition resolved. D-dimer levels may be used to monitor the effectiveness of DIC treatment.

When is it ordered?
D-dimer may be ordered when a patient has symptoms of DVT, such as leg pain, tenderness, swelling, discoloration, edema; or symptoms of PE, such as labored breathing, coughing, and lung-related chest pain. D-dimer is especially useful when the doctor thinks that something other than DVT or PE is causing the symptoms. It is a quick, non-invasive way for the doctor to help rule out abnormal or excess clotting.


When a patient has symptoms of DIC, such as bleeding gums, nausea, vomiting, severe muscle and abdominal pain, seizures and oliguria (decreased urine output), a D-dimer test may be ordered, along with a PT, aPTT, fibrinogen, and platelet count to help diagnose the condition. D-dimer may also be ordered at intervals when a patient is undergoing treatment for DIC to help monitor its progress.
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Old 12-17-2008, 09:13 AM
jvargocpc jvargocpc is offline
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I'm happy to see that someone else uses labtestsonline!

I had looked at using 790.92, but wasn't sure because the D-dimer is a test of the products of coagulation, rather than a test of the clotting mechanism. I had also looked at fibrinolysis, 286.6, since the D-dimer measures levels of fibrinolysis, but wasn't sure of that either.

It looks like there isn't a good answer for this, but thanks for the help everyone! I know that I'm at least not overlooking something that's right in front of me!
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Old 12-17-2008, 09:52 AM
pharmon pharmon is offline
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Is this a free website? It sounds wonderful. I'd like to research other stuff on it. Thanks for taking the time and posting this information. It has benefited me for the future.
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Old 12-17-2008, 10:38 AM
Anna Weaver Anna Weaver is offline
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Default D-dimer

Quote:
Originally Posted by pharmon View Post
Is this a free website? It sounds wonderful. I'd like to research other stuff on it. Thanks for taking the time and posting this information. It has benefited me for the future.

If your talking about labtestsonline, yes, it's free. It's a wonderful site, just type in your test and it gives you an amazing amount of information.

http://www.labtestsonline.org/
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

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