DVT (Deep Vein Thrombosis)

When documenting DVT, it is important to specify if it is Acute or Chronic.

Following coding guidelines, if you document “DVT”, it is assumed to be an acute condition and the code is 453.40 (Acute venous embolism and thrombosis of unspecified deep vessels of lower extremity)

If the patient is on anticoagulant therapy then the appropriate documentation should be “Chronic DVT on Coumadin” or “Chronic DVT on an anticoagulant” and the code is 453.50 (Chronic venous embolism and thrombosis of unspecified deep vessels of lower extremity) and V58.61 (Long term (current) use of anticoagulants)

If the DVT is NOT considered acute and the patient is NOT on anticoagulant therapy, the appropriate documentation should be “H/O DVT” and the code is V12.51 (Personal history of venous thrombosis and embolism)

 

ULCERS

There are two types of ulcers, non-pressure ulcer or pressure ulcer also known as decubitus.

Pressure ulcers require two codes, one for the site of the ulcer and one for the stage. The codes for the sites are 707.00 – 707.09. The codes for the stages are 707.20-707.25.

707.25 Pressure ulcer, unstageable is only assigned if the ulcer is covered by eschar, has been treated with skin or other graft, or is documented as deep tissue injury but not documented as due to trauma.

707.20 Pressure ulcer, unspecified stage is assigned when there isn’t any stage specified.

Non-Pressure Ulcer requires only one code for the site. The codes range is 707.10-707.19.

 

CKD AND HYPERTENSION

When a patient has a diagnosis of CKD and Hypertension; this is an assumed cause and effect relationship per coding guidelines. It is considered Hypertensive Chronic Kidney Disease.

The code for CKD would be 585.X (X = stage) and the Hypertension becomes 403.90 Hypertensive Chronic Kidney Disease when the CKD is stage 1-4 or 9. For CKD stage 5 or 6 the Hypertension code is 403.91.

You would not assign code 401.9 Hypertension Unspecified, when the patient has a diagnosis of CKD as well.

 

DIABETES “Buddy” CODE SYSTEM

When coding Diabetes with a manifestation, coding guidelines require two ICD-9 codes to indicate the entire diagnosis.

The following are the Diabetes with manifestation codes:

·         250.40 Diabetes with renal manifestations

·         250.50 Diabetes with ophthalmic manifestations

·         250.60 Diabetes with neurological manifestations

·         250.70 Diabetes with peripheral circulatory disorders

·         250.80 Diabetes with other specified manifestations

 

 

Each time one of these codes is chosen as the diagnosis a second (“buddy”) ICD-9 code MUST be assigned as well.

The following are some examples of the “buddy” code. This is not an all inclusive list

·         250.40 & 585.X CKD

·         250.50 & 362.2 Proliferative Diabetic Retinopathy

·         250.60 & 357.2 Peripheral Neuropathy in Diabetes

·         250.70 & 443.81 Peripheral Vascular Disease in other specified diseases (such as diabetes)

·         250.80 & 707.10 Ulcer of lower limb, unspecified

 

 

If you just code 250.40 Diabetes with renal manifestations, this is not enough information to indicate the complete diagnosis. For instance the manifestation could be Nephropathy, CKD, Microalbuminuria or Proteinuria. You would need to code the second (“buddy”) diagnosis as well to fully explain the patient’s condition.

Example: CKD Stage III due to Diabetes would be coded:

·         250.40 Diabetes with renal manifestations

·         585.3 CKD Stage III