Oncology & Hematology Coding Alert

Laterality is your guide to the best DVT code.

Coding for deep vein thrombosis (DVT) in ICD-10-CM will require attention to detail such as which vein in specific was involved and on which side. To make things easy, just adopt this simple strategic approach.

Diagnosis refresher: A thrombosis is a solid mass that forms locally in a vessel causing an obstruction. An embolism is most often a piece of a thrombus broken free and carried by the bloodstream causing obstruction of a vessel. The obstructions are formed from plaque or fatty deposits of the blood. The codes featured here are specific to deep vessels, and that means the codes are appropriate for DVT. You do not report these codes for any thrombosis in the superficial veins. The codes are also specific to acute cases, as opposed to chronic.

ICD-9-CM code:

• 453.42 , Acute venous embolism and thrombosis of deep vessels of distal lower extremity
  

ICD-10-CM codes:

• I82.44_, Acute embolism and thrombosis of ____ tibial vein
  
• I82.49_, Acute embolism and thrombosis of other specified deep vein of ____ lower extremity
• I82.4Z_, Acute embolism and thrombosis of unspecified deep veins of ____distal lower extremity
  

Each of the above ICD-10-CM codes above are incomplete without the final digit. Choose the sixth character based on the side(s) involved:

• 1, right
  
• 2, left
  
• 3, bilateral
  
• 9, unspecified.
  

ICD-9-CM 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. Note that peroneal means fibular. Don’t confuse it with perineal, which relates to the genital area.

ICD-10-CM changes: ICD-10-CM expands your options dramatically, creating 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: Your clinician’s documentation will need to be clear about the vessel(s) and limb(s) involved for you to choose the most appropriate ICD-10-CM code. Remember that “other” means the physician documented the type, but ICD-10-CM doesn’t offer a code specific to the documented type. “Unspecified” means the physician did not document the needed information.

Coder tips: The codes shown here are specific to acute, deep vein, and distal lower extremity diagnoses. You’ll see similarly (and sometimes even more) detailed ICD-10-CM coding options for chronic and proximal lower extremity diagnoses, as well as diagnoses specific to other anatomic features, such as thoracic or upper extremity vessels. If these are diagnoses you see in your practice, take the time to review those new code ranges.

Remember: When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update. The planned date for implementation is Oct. 1, 2014.