Q&A Discuss Acute vs Chronic DVT for coding Coumadin therapy

[jessicat35]

Hi there! One of your brand new coders seeking certification in June and I was lucky enough to land a coding job before my test. So, I work outpatient labs and radiology and I have had some conflicting guidance regarding coding DVT prophylaxis and was hoping I could get some clarification. I had been just using the acute codes for DVT or PE (453.40 or 415.19) and was recently told that Coumadin therapy takes place in the "chronic" phase of illness and therefore should be using 453.50 or 416.2. Any thoughts or suggestions on this when the documentation doesnt specify acute or chronic? Thanks! Love you guys!
Jess

 

[Alicia Scott]

This is a hard concept. You should only use an acute code if the pt is in an acute state. When they first come in and are diagnosed and treated. This is the initial visit. It can start in the ER then a pt would be admitted and it would still be an acute code used. After the patient is d/c then you are looking at chronic codes. Those being 453.50 and 416.2. Below is some more information about the code 416.2.
416.2 - Chronic pulmonary embolism
Use additional code(s), if applicable, for associated long-term (current) use of anticoagulants (V58.61)
Excludes: personal history of pulmonary embolism (V12.55)​

Plain English Description

A pulmonary embolism is a blood clot that has broken away from the wall of a vein in one location and traveled to the lungs where it gets lodged in the arteries, blocking blood flow to the heart and lungs. Nearly 90 percent of pulmonary emboli have formed from deep vein thrombosis in the legs but can also be caused by pieces of atherosclerotic plaque, cellular debris in conditions such as sickle cell anemia, fat escaping from the bone marrow when a fracture occurs, or from amniotic fluid during childbirth. Emboli occur as complications of surgery, bed confinement, severe varicose veins or phlebitis, recent heart attack or stroke, and chronic illness, like congestive heart failure. Oral contraceptives, obesity, broken leg, clotting disorders, sitting for long periods of time, and congenital heart defects all cause increased risk.|Chronic pulmonary embolism occurs when small blood clots travel repeatedly to the lungs over a period of several years. Symptoms of shortness of breath, leg swelling, and general weakness build up gradually. Emboli cause rapid breathing, chest pain, anxiousness, increased pulse rate, dizziness, and fainting. Sudden death can occur. Patients are hospitalized, given anticoagulants to dissolve clots and prevent new ones, and oxygen therapy to increase blood levels. Some patients will require surgical removal of the clot and some require placement of a device that filters blood returning to the heart and lungs until the clot dissolves.​

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[jessicat35]

Thanks I appreciate it!