When treating a patient for a deep vein thrombus or pulmonary embolism, it is important to specify whether the condition is acute or chronic, and if you are billing for an initiation or continuation of treatment. Because there is no explicit timeframe for when to classify deep vein thrombosis or a pulmonary embolism as chronic or acute, Harvard Pilgrim would like to offer the following coding tips.
Typically, an acute thrombus is diagnosed in a hospital setting and initially treated there with long-term anticoagulants. Chronic clots have already been diagnosed and usually require the continuation of anticoagulants. However, if the documentation does not specify acute or chronic, the coder must use acute as a default code per the ICD-10-CM-index to disease and injuries.
Documentation that does not match the code being billed could lead to an audit.
Use the following diagnosis codes for patients you are treating for initial episodes and those for whom you are continuing treatment:
- Initial episode:
- Acute pulmonary embolism: 126.99
- Acute deep vein thrombosis: 182.40X
- Already on anticoagulant medication:
- Chronic pulmonary embolism: 127.82
- Chronic deep vein thrombosis: 182.50X
Additionally, when an anticoagulant medication — such as coumadin, for example — is used for prophylactic prevention following a resolved episode of deep vein thrombosis or pulmonary embolism, you should use one of the following “history of” codes, rather than a code signifying that the condition is acute or chronic: Z86.711 (History of pulmonary embolism); Z86.718 (History of deep vein thrombosis).
The more clearly and completely conditions are documented on a patient’s medical record, the more likely it is that treatment will be reimbursed appropriately and swiftly.