ICD-10 Coding for Bilateral Deep Vein Thrombosis(I82.403, I82.413)
Complete ICD-10-CM coding and documentation guide for Bilateral Deep Vein Thrombosis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Deep Vein Thrombosis
I82.4-I82.5Primary Range
Embolism and thrombosis of veins of lower extremities
This range includes codes for acute and chronic DVT of the lower extremities, including bilateral cases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I82.403 | Acute embolism and thrombosis of unspecified deep veins of lower extremity, bilateral | Use when bilateral DVT is confirmed but specific veins are not identified. |
|
| I82.413 | Acute embolism and thrombosis of femoral vein, bilateral | Use when imaging confirms acute bilateral DVT of the femoral veins. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for bilateral deep vein thrombosis
Essential facts and insights about Bilateral Deep Vein Thrombosis
Primary ICD-10-CM Codes for bilateral deep vein thrombosis
Decision Criteria
clinical Criteria
- Presence of bilateral symptoms and elevated D-dimer.
documentation Criteria
- Lack of specific vein identification in documentation.
Applicable To
- Acute bilateral DVT of unspecified deep veins
Clinical Validation Requirements
- Bilateral leg swelling and pain
- Positive D-dimer test
- Pending or inconclusive imaging
Code-Specific Risks
- Risk of under-documentation if specific veins are not identified.
Coding Notes
- Ensure documentation specifies 'bilateral' and 'acute' to avoid coding errors.
I82.413 - Acute embolism and thrombosis of femoral vein, bilateral
Use when imaging confirms acute bilateral DVT of the femoral veins.
Applicable To
- Acute bilateral DVT of femoral veins
Excludes
- Chronic DVT (I82.5-)
- Superficial thrombophlebitis (I80.2-)
Clinical Validation Requirements
- Imaging confirming bilateral femoral vein involvement
- Acute onset of symptoms
Coding Notes
Ensure documentation specifies 'femoral veins' and 'bilateral' for accurate coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long-term (current) use of anticoagulants
Z79.01Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Deep Vein Thrombosis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I82.403.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Use templates to ensure all necessary details are captured., Regular training on documentation standards.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify imaging and clinical history to confirm acuity.
Impact
Inaccurate or incomplete documentation can lead to audit findings.
Mitigation Strategy
Implement regular documentation audits and training sessions.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Bilateral Deep Vein Thrombosis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Deep Vein Thrombosis
Use these documentation templates to ensure complete and accurate documentation for Bilateral Deep Vein Thrombosis. These templates include all required elements for proper coding and billing.
Acute Bilateral DVT in Emergency Department
Specialty: Emergency MedicineRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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