Radiology Coding Alert

See if you avoided the acute vs. chronic pitfalls.

Have you mastered ICD-9 2010 embolism coding? Check your progress by reviewing the answers to the quiz on page 3.

Scenario 1: Catch 1 Key Term for 453.xx Success

Answer: C. 453.51 (Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity)

Why: Distinction based on a problem’s acute or chronic nature is a major change from 2009 to 2010 for the embolism and thrombosis codes. In Scenario 1, the documentation states “chronic” thrombosis, so new code 453.51 is most appropriate for this case. For services before Oct. 1, 2009, you would have reported 453.41 (Venous embolism and thrombosis of deep vessels of proximal lower extremity) for Scenario 1. But ICD-9 2010 revises 453.41 so it applies only to “acute” cases. The new descriptor reads: “Acute venous embolism and thrombosis of deep vessels of proximal lower extremity.” The acute embolism codes are appropriate if someone has a new embolism, says Jill Young, CPC, CEDC, CIMC, president of Young Medical Consulting in East Lansing, Mich.

In Scenario 1, the thrombosis is “chronic,” not “acute,” so new “chronic” code 453.51 is correct.

Scenario 2: Follow Anatomy for Cephalic Code

Answer: B. 453.81 (Acute venous embolism and thrombosis of superficial veins of upper extremity)

Reason: In Scenario 2, the radiologist documents acute embolism, and the cephalic is a superficial vein, so 453.81 is the most appropriate code. Tip: ICD-9 notes following 453.81 list the antecubital, basilic, and cephalic as superficial upper extremity veins. You can see notes like this one, as well as new codes and guidelines, at www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm.

FYI: Code 453.8 (Other venous embolism and thrombosis; of other specified veins) may have been your go-to option for the upper body before Oct. 1, but ICD-9 2010 revises 453.8’s descriptor to read “Acute venous embolism and thrombosis of other specified veins.” As a result, this code is appropriate only for acute embolism as of Oct. 1.

Scenario 3: Pick Proper Pre-Existing Clot Code

Answer: B. 416.2 (Chronic pulmonary embolism)

Rationale: You should report new code 416.2 when a patient with unexplained dyspnea (786.09, Dyspnea and respiratory abnormalities; other) or a history of pulmonary hypertension (416.8, Other chronic pulmonary heart diseases) displays evidence of pulmonary embolism on a CT scan or pulmonary angiogram, without evidence of a recent event, explains Philip Marcus, MD, MPH, FACP, FCCP, at the St. Francis Hospital Heart Center in Roslyn, N.Y.

The V code (V12.51, Personal history of venous thrombosis and embolism, pulmonary embolism) instead would apply 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, Marcus says.

And you should use 415.19 (Pulmonary embolism and infarction; other) for a new, acute pulmonary embolism.