General Surgery Coding Alert

When you report lower-extremity varicose veins with complications using ICD-9, you have just four code choices. But once ICD-10 goes into effect on October 1, you’ll have more than 30 codes to choose from.

Read on to learn what diagnostic information you’ll need so that you can accurately code the patient’s condition. Because many payers have specific limitations for covering varicose vein treatments such as endovenous ablation therapy (EVAT or EVA), you’ll need to get the diagnostic low-down to ensure that your surgeons can show medical necessity for their work.

ICD-9: The ICD-9 code choices are as follows:

• 454.0 — Varicose veins of lower extremities with ulcer

• 454.1 — … with inflammation

• 454.2 — … with ulcer and inflammation

• 454.8— … with other complications.

You’ll have many more code choices for reporting complications with lower-extremity varicose veins under ICD-10 using category I83.- (Varicose veins of lower extremities). Most of the additional specificity of these codes involves more-specific identification of site and complications.

ICD-10: ICD-10 provides four subcategories that parallel the ICD-10 codes, but they require fifth and possibly sixth digits to assign the complete code. The subcategories are as follows:

• I83.0- — Varicose veins of lower extremities with ulcer

• I83.1- — … with inflammation 

• I83.2- — … with both ulcer and inflammation

• I83.8- — … with other complications.

Fifth digit: Under ICD-10, you’ll also need to assign a fifth digit for these codes. For I83.0-through I83.2-, the fifth digits identify right (1), left (2), or unspecified (0) lower extremity. For I83.8- the fifth digit identifies pain (1) or edema/swelling (9).

Sixth digit: For many of the codes, you’ll also need to assign a sixth digit to zero in on the site of the varicose vein, as follows:

• 1 — thigh

• 2 — calf

• 3 — ankle

• 4 — heel and midfoot

• 5 — other part of foot

• 8 — other part

• 9 — unspecified.