Anesthesia Coding Alert

Check all records for documentation of right, left, or bilateral.

ICD-10 will bring code changes for every specialty, but cardiology will be especially affected. When your anesthesiologist participates in surgery to treat deep vein thrombosis (DVT) after October 2013, be prepared to choose from much more detailed diagnosis options.

Currently ICD-9-CM includes one code for DVT: 453.42 (Acute venous embolism and thrombosis of deep vessels of distal lower extremity). ICD-10 will expand to 12 choices:

• I82.441, Acute embolism and thrombosis of right tibial vein
• I82.442, Acute embolism and thrombosis of left tibial vein
• I82.443, Acute embolism and thrombosis of tibial vein, bilateral
• I82.449, Acute embolism and thrombosis of unspecified tibial vein
• I82.491, Acute embolism and thrombosis of other specified deep vein of right lower extremity
• I82.492, Acute embolism and thrombosis of other specified deep vein of left lower extremity
• I82.493, Acute embolism and thrombosis of other specified deep vein of lower extremity, bilateral
• I82.499, Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity
• I82.4Z1, Acute embolism and thrombosis of unspecified deep veins of right distal lower extremity
• I82.4Z2, Acute embolism and thrombosis of unspecified deep veins of left distal lower extremity
• I82.4Z3, Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral
• I82.4Z9, Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity.

ICD-9 coding rules: Inclusion notes with 453.42 tell you the code is appropriate for diagnoses connected to the calf, lower leg NOS, or the peroneal or tibial veins.

ICD-10 changes: ICD-10 creates codes that differ based on whether the diagnosis involves the right leg, the left leg, both legs, or an unspecified leg. You also must choose among codes that differ based on whether the vein involved is the tibial, another specified vein, or is not specified.

Documentation: Physician documentation will need to be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10 code. If the anesthesiologist doesn't specify that level of detail, double check the surgeon's record. Remember that "other" means the physician documented the type, but ICD-10 doesn't offer a code specific to the documented type. "Unspecified" means the physician did not document the needed information.