Leg complaint: Which ICD-9 code should you go for?

We all know by now that effective October 1, 2009, services require more specificity.


ICD-9 2010 brings a huge expansion in thrombosis and embolism coding options. Therefore, you need a keen eye to spot precise anatomic locations and to determine whether a problem is chronic or acute. You can get the low down on these ICD 9 codes online by signing up for a one-stop coding website.


Which ICD-9 code should you use if your documentation indicates the following?


* A 69-year-old male patient complains of chronic swelling and pain in his left leg. Thorough history and exam has been performed.

* Ordered CBC, Chem panel, D-dimer, and Doppler ultrasound of leg.

* Initiation of Heparin therapy to avert worsening and hospital admission.

* The patient suffered from proximal thrombosis, same leg, Aug. 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


The right answer would be the third option. Here's why: Distinction based on a problem's chronic or acute nature is a major change from 2009 to 2010 for the embolism and thrombosis codes. Since the documentation states 'chronic' thrombosis, the new code 453.51 is just apt for this case.


Prior to October 1, you would have had to report 453.41 (Venous embolism and thrombosis of deep vessels of proximal lower extremity) here. But ICD-9 2010 revises 453.41 so it is applicable only to acute cases. According to the new descriptor: Acute venous embolism and thrombosis of deep vessels of proximal lower extremity. These acute embolism codes are appropriate if someone has a new embolism.


In the example cited, the thrombosis is chronic, not acute; as such new chronic code 453.51 is correct here.