Coding corner: Vascular disease

Vascular disease includes conditions involving the blood vessels. Some affect the arteries, such as peripheral vascular disease, while others affect the veins, such as deep vein thrombosis. There are many risk factors for vascular disease, including age, family history, diabetes, high cholesterol, hypertension, smoking, inactivity, injury and obesity.

Here are some important things to consider when coding for vascular disease:

• Has the condition resolved because of surgical intervention or otherwise, and no longer requires any form of treatment?
• Is the condition chronic and does it require ongoing treatment, monitoring or assessment? State the status and management plan.
• Is the vascular disease considered a complication of another chronic condition, such as diabetic angiopathy?
• Are there any complications resulting from the vascular disease, such as gangrene or skin ulcer?
• Is there a reason for long-term anticoagulant therapy, such as chronic deep venous thrombosis or chronic pulmonary embolism?

Peripheral vascular disease

Sometimes referred to as peripheral arterial disease or peripheral angiopathy, PVD is a circulatory condition that affects the arteries resulting in reduced blood flow to the extremities, typically in the legs.

The most common symptom is intermittent claudication, which is pain while walking that resolves after a few minutes of rest. The location of the pain depends on the site of the narrowed or blocked artery.

If you document PVD without further specificity, use ICD-10 code I73.9, PVD, unspecified. This code also includes intermittent claudication, peripheral angiopathy, and spasm of artery.

Documentation of PVD is extremely important in patients with diabetes mellitus as coders can assume the cause-and-effect relationship between the two conditions. See examples below:

• E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
• E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene

NOTE: According to the 2016 second quarter AHA Coding Clinic — an official coding source recognized by the Centers for Medicare & Medicaid Services — instructions have been released on the assumed cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves and circulatory system. The following example shows the ICD-10-CM index format for certain conditions linked to Type 2 diabetes:

Diabetes, diabetic (mellitus)(sugar)
      Type 2 E11.9
          With
              Amyotrophy E11.44                             (Relationship assumed)
              Chronic kidney disease E11.22
              Circulatory complications E11.59
              Peripheral angiopathy E11.51

Within a date of service, if a provider has documented diabetes and peripheral angiopathy — or any condition following ‘with’ in the index — the conditions are assumed to be related even if the doctor doesn’t specifically document the relationship.

Deep Vein Thrombosis - DVT
This condition occurs when the blood thickens and clumps together forming a clot. This can take place within one or more deep veins and is most prevalent within veins of the legs.

Common symptoms of DVT can include pain, redness or discoloration, swelling or warmth of the affected leg. The location of these symptoms depends on the location of the clot.

When coding DVT, acuity of the condition is very important and the physician should reflect it in their documentation:

• Acute DVT refers to a new thrombosis that requires the initiation of anticoagulant therapy
• Chronic DVT is an old or established thrombus that requires long term and sometimes life-long anticoagulation therapy.

It’s important to remember that specific code assignment is based solely on physician documentation. It may be necessary to query the physician for clarification if acuity cannot be determined.

Coding PVD and DVT

To code PVD or DVT to the highest specificity, look for these key components:

• Location of affected artery or vein
• Laterality — left, right or bilateral
• The cause, if known
• Acuity
• Symptoms, including intermittent claudication or rest pain
• Complications such as ulceration or gangrene