These two conditions are often miscoded in the outpatient setting. When documentation supports prophylactic treatment with long-term use of anticoagulants, the acute or chronic codes should not be reported.
It is important to define the thrombus as being acute or chronic. There is no specific time frame to classify the embolus as being acute or chronic. An acute thrombus is typically treated and diagnosed in the hospital setting and requires initiation of anticoagulation therapy with an end date. Thrombi diagnoses as chronic typically require continuation of anticoagulant medications.
Note: When anticoagulant Warfarin is used for prophylactic prevention following a resolved episode of DVT or Pulmonary Embolism, the acute/chronic codes cannot be assigned and only warrants the capture of Z codes for the history of a condition and anticoagulation status.
In addition to coding chronic anticoagulation, it is important to code and document the primary diagnosis for which chronic anticoagulation was originally prescribed. The following table serves as a reference point to the clinician for the five most common causes of embolic formation:
46 y/o M presents for warfarin refill. INR monitored biweekly, last Coaguchek reading of 2.1 last week. Log reports 3 months of INR all within range of 2.0-2.3. Greenfield filter placed 2009, no reported problems.
Diagnosis: History of PE
Coded as:
Z86.711 Personal history of pulmonary embolism
Z79.01 Long-term use of anticoagulants
Z95.828 presence of other vascular implants
* The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.