Pulmonology Coding Alert

Acute or chronic? Count the ways!

Facing the task of reporting pulmonary embolism can be confusing if you don't arm yourself with the right information. Put an end to your struggles by identifying the details of an existing clot.

Paint an Accurate Picture Using Pulmonary Embolism Newbie In 2009, ICD-9 debuted 416.2 (Chronic pulmonary embolism). This code comes in handy when a patient with unexplained dyspnea (786.09) or with a history of pulmonary hypertension (416.8) displays evidence of pulmonary embolism on a CT scan or pulmonary angiogram, without evidence of a recent event, notes Philip Marcus, MD, MPH, FACP, FCCP, chief of pulmonary medicine at the St. Francis Hospital Heart Center in Roslyn, N.Y.

Use 416.2 to explain chronic symptoms rather than a new, acute pulmonary embolism, which you'd report using 415.11 (Iatrogenic pulmonary embolism and infarction), 415.12 (Septic pulmonary embolism), or 415.19 (Pulmonary embolism and infarction; other).

Advantage: When you know the difference between an old thrombus and an acute one, you'd be able to document the need for continuing an established therapy versus initiation or intensification of anticoagulant therapy, according to an Agency for Healthcare Research and Quality Coordination and Maintenance Committee statement.

Heads up: Use the V code V12.51 (Personal history of venous thrombosis and embolism, pulmonary embolism) when there is a history of a pulmonary embolism, but it is no longer present and not relevant to the reason for a current evaluation.

Get Better Understanding with These Scenarios

Scenario 1: A pulmonologist works up a patient with secondary pulmonary hypertension (416.8) and determines that an existing clot, remains undissolved in one of the pulmonary arteries. You would report a chronic pulmonary embolism (416.2).

Scenario 2: A patient presents with signs and symptoms of chronic obstructive pulmonary disease (491.21). Upon evaluation, the pulmonologist finds a history of having a small subsegmental pulmonary embolism that is no longer on active therapy. In this case, you should code 416.2 for the diagnosis.

Important: Don't forget to document the event leading to an acute pulmonary embolism using the following codes:

• 453.40 -- Acute venous embolism and thrombosis of deep vessels of lower extremity, deep vein thrombosis NOS
• 453.41 -- Acute venous embolism and thrombosis of deep vessels of proximal lower extremity, such as femoral, thigh, upper leg NOS
• 453.42 -- Acute venous embolism and thrombosis of deep vessels of distal lower extremity, such as calf or lower leg NOS
• 453.84 -- Acute venous embolism and thrombosis of axillary vein
• 453.87 -- Acute venous embolism and thrombosis of other thoracic veins

Just the same, a counterpart for chronic pulmonary embolism serves the same purpose. They are:

• 453.50 -- Chronic venous venous embolism and thrombosis of unspecified deep vessels of lower extremity
• 453.51 -- Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity
• 453.71 -- Chronic venous embolism and thrombosis of superficial veins of upper extremity.

Background: Pulmonary embolism is a blood clot in the lung usually comes from smaller vessels in the leg, pelvis, arms, or heart. The clot travels upward through the vessels of the lung continuing to reach smaller vessels until it gets trapped in a vessel that is too small to allow it to continue farther. The block prevents any further blood from traveling to that section of the lung.