Radiology Coding Alert

Distinguishing superficial veins from deep will keep your claims clean.

In all the excitement of adding new CPT and HCPCS changes to your files, you have to make sure your ICD-9 coding stays on track, too. The 2010 expansion in thrombosis and embolism coding options requires a keen eye to spot precise anatomic locations and whether a problem is chronic or acute.

Dig into these three scenarios to see if you can choose the proper code for services performed on or after Oct. 1, 2009. Then turn to page 5 for the answers.

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

For services Oct. 1, 2009, or later, which ICD-9 code should you choose if your documentation indicates the following?

• Male patient, 69, complains of chronic swelling and pain in his left leg. Comprehensive history and exam performed.

• Ordered tests include CBC, Chem panel, D-dimer, and Doppler ultrasound of leg ... Ultrasound indicates significant iliofemoral chronic venous thrombosis.

• Initiation of Heparin therapy to prevent worsening and hospital admission.

• Patient had proximal thrombosis, same leg, in August 2008.

A. 453.41 -- Venous embolism and thrombosis of deep vessels of proximal lower extremity

B. 453.41 -- Acute venous embolism and thrombosis of deep vessels of proximal lower extremity

C. 453.51 -- Chronic venous embolism and thrombosis of deep vessels of proximal lower extremity

Scenario 2: Follow Anatomy for Cephalic Code

For services Oct. 1, 2009, or later, which ICD-9 code should you choose if your documentation indicates the following?

Patient presents with pain and swelling in his left arm; he also reports vague shoulder and neck pain. The exam reveals low-grade fever, mild cyanosis of the left arm, and elevated jugular venous distention. The radiologist diagnoses an acute cephalic vein embolism and orders catheter-directed anticoagulant therapy.

A. 453.8 -- Other venous embolism and thrombosis; of other specified veins

B. 453.81 -- Acute venous embolism and thrombosis of superficial veins of upper extremity

C. 453.82 -- Acute venous embolism and thrombosis of deep veins of upper extremity

Scenario 3: Pick Proper Pre-Existing Clot Code

In a patient with secondary pulmonary hypertension (416.8, Other chronic pulmonary heart diseases), the radiologist finds a pre-existing undissolved clot in one of the pulmonary arteries. For services Oct. 1, 2009, or later, which code describes this clot?

A. 415.19 -- Pulmonary embolism and infarction; other

B. 416.2 -- Chronic pulmonary embolism

C. V12.51 -- Personal history of certain other diseases; venous thrombosis and embolism.