Popliteal DVT and prob PE

arsusott@msn.com

I have read through some older post regarding these 2 diagnosis but this questions is slightly different. I have a patient that was diagnosed with Popliteal DVT and prob PE at a different hospital and d/c on 1/16 admitted to our hospital 1/20 with epistaxis 2nd to Coumadin. My question is how long do I consider the PE and DVT acute? In my head I think it is acute it has only been 4 days... but do I need to query for acuity? Patient is still on Coumadin and pharmacy is adjusting as needed. I know if it was a MI we would code the code for subsequent treatment but there isn't a code for subsequent treatment for PE and DVT so am wondering if I can code them to acute and use the MCC from the PE? Mainly, I was just wondering if anyone had any guidelines on how long a PE and DVT are considered acute.

Thanks in advance,
Angela Susott

arsusott@msn.com

Christina, thanks so much. It would be great if you would let me know what the coders "coded" out in the end.
Angela

wfreeman

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dvitalone1

I was just wondering what the final determination was for the question about how long is a PE considered acute. I have a pt now that was admitted for CHF and per consultation notes "just hospitalized in Nov 2010 for PE continues on coumadin." Thanks!
Dawn

david.smith

Here is the most recent related Coding Clinic that I could find. Note that there is no timeline to distinguish between acute and chronic PE status. The guidance is to query if the documentation doesn't specify the acuity. From reading the CC, it would appear the management of the condition could point toward acute v. chronic. It appears that it could be considered acute for at least 6 months (or longer), but it states that "codes should be assigned on the basis of the provider's documentation."
Interestingly, if the documentation is either Acute PE or just PE it will be coded/reported with the same code (415.19 MCC). Since the chronic form is only a CC, I could see this being a RAC target if the documentation is not specific as to the status (for MCC/CC on subsequent encounters). Probably best to query.

"Effective October 1, 2009, a new code (416.2) has been created to describe chronic pulmonary embolism to distinguish between patients who are being treated for an acute pulmonary embolism and patients with chronic pulmonary embolism who are being maintained on anticoagulant therapy for an extended period of time. Previously the classification did not differentiate between acute and chronic pulmonary embolism.

An embolus is a blood clot that most commonly originates in the veins of the legs (deep vein thrombosis). The blood clot can dislodge and travel as an embolus to other organs in the body. A pulmonary embolism is a clot that lodges in the lungs, blocking the pulmonary arteries and reducing blood flow to a region of the lungs.

Pulmonary embolic disease may be acute or chronic (longstanding, having occurred over many weeks, months or years). In the majority of cases acute pulmonary emboli do not cause chronic disease because the body’s mechanisms will usually break down the blood clot. An acute embolus is usually treated with anticoagulants (e.g., intravenous heparin and warfarin or oral Coumadin) to dissolve the clot and prevent new ones.

For acute pulmonary embolism, anticoagulant therapy may be carried out for 3 to 6 months. Therapy is discontinued when the embolus dissolves. However, it can persist. In patients with recurrent pulmonary embolic disease while on blood thinners or patients who cannot tolerate blood thinners, a filter can be placed to interrupt the vena cava. The device filters the blood returning to the heart and lungs. In some cases of chronic pulmonary embolism, the clot develops fibrous tissue, and surgery is needed to remove this fibrous tissue.

Thrombolytic therapy (e.g., streptokinase, urokinase, and tissue plasminogen activator) is another treatment option for acute pulmonary embolism. However, thrombolytics are generally contraindicated in patients that are pregnant, have had a recent cerebrovascular accident, have a bleeding disorder, or have had recent surgery.

Code 415.19, Pulmonary embolism and infarct, Other, is used for an acute pulmonary embolism. There is no specific timeframe that distinguishes acute from chronic pulmonary embolism. These codes should be assigned on the basis of the provider’s documentation. Query the provider for clarification if the documentation is unclear." Coding Clinic, 4th Q. 2009

dvitalone1

Thank you so much!! Unfortunatley, since we are a new department, I do not have access to any time of coding clinics


Dawn M. Vitalone, RN