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Embolism and thrombosis — ICD-10 documentation and coding guidance

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Provides ICD-10 documentation and coding guidance for embolism and thrombosis (including DVT and PE), and documentation best practices for coding acute, chronic, and history of events; intended for clinicians and coding staff working with Independence Administrators members.

Policy Summary

PayerIndependence Administrators

PolicyEmbolism and thrombosis — ICD-10 documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Next Review DateN/A

Key ActionDocument type (PE vs DVT), acuity (acute vs chronic), provoked vs unprovoked, treatment and duration, and anticoagulation status; include rationale if treatment >3 months for PE or >6 months for DVT.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3 monthsacute PE coding window

6 monthsacute DVT coding window

4 weekschronic DVT persistence

Z79.01 / Z79.0-codes for long-term anticoagulation

Documentation-driven coding criteria

Documentation and coding criteria to support coding decisions for embolism and thrombosis:

ALL of the following must be documented to code an active/current embolism or thrombosis

Type of event
- Pulmonary embolism (PE) — specify acute vs chronic, and whether with or without acute cor pulmonale
- Deep vein thrombosis (DVT) or other specified site — specify vein involved and laterality for chronic DVT coding (5th and 6th characters)
Acuity: document whether the event is acute or chronic (repeat radiologic studies confirming persistent clot > 4 weeks required to define chronic DVT)
Provoked vs unprovoked status of the event
Anticoagulation treatment: document current anticoagulant use and duration of therapy (document duration in your note)
Treatment rationale when duration exceeds usual acute windows: if treatment > 3 months for PE or > 6 months for DVT, include clear rationale why therapy is ongoing; otherwise code as history
If long-term anticoagulation is present
- Use Z79.0- or Z79.01 to indicate long-term (current) use of anticoagulants as applicable
- If anticoagulation extends beyond acute coding windows but is clearly clinically indicated, continue to code as acute/current with documentation of rationale

ICD-10 coding guidance

Covered/neutral ICD-10 codesICD-10

I26.99	Other pulmonary embolism without acute cor pulmonale
Z86.711	Personal history of pulmonary embolism
I82.432	Acute embolism and thrombosis of left popliteal vein
Z86.718	Personal history of other venous thrombosis and embolism
I82.5-	Chronic DVT codes (5th character for vein involved; 6th character for laterality)
I82.532	Chronic embolism and thrombosis left popliteal vein
Z79.01	Long-term (current) use anticoagulants

Acute PE coding window — up to 3 months

Acute PE coding windowCode as acute while the patient is anticoagulated for up to three months; document duration in the record; after three months continue coding as acute only if clinically appropriate.

Documentation requirementDocument anticoagulation status and duration (note example: patient on anticoagulant two months into a three-month course).

Post‑3 month guidanceIf treatment extends beyond three months without documented clinical rationale, code as history rather than active disease.

Acute DVT coding window — up to 6 months

Acute DVT coding windowCode as acute while the patient is anticoagulated for up to six months; document duration in the record; continue coding as acute past six months only if clinically appropriate.

Documentation requirementDocument anticoagulation status and duration (note example: patient continues warfarin two months into a six-month course).

Post‑6 month guidanceIf treatment extends beyond six months without documented clinical rationale, consider coding as history rather than active disease unless clinically justified.

Chronic DVT definition — radiologic persistence >4 weeks

Chronic DVT thresholdChronic DVT is defined when repeat radiologic studies (ultrasound, CT, etc.) confirm persistent clot greater than four weeks.

Coding for chronic DVTUse I82.5- series for chronic DVT; specify 5th character for the vein involved and 6th character for laterality (right, left, bilateral, unspecified).

ExampleI82.532 — Chronic embolism and thrombosis of left popliteal vein (example usage).

Documentation requirements and actions for providers

Documentation Required

Required documentation elements for embolism/thrombosis coding

Document the specific type of event (PE vs. DVT and other specified site), acuity (acute vs. chronic, and if acute note presence/absence of acute cor pulmonale), whether the event was provoked or unprovoked, the anticoagulation treatment and current anticoagulation status, and the length of treatment. If treatment extends beyond typical acute windows (greater than 3 months for PE or greater than 6 months for DVT) include clear clinical rationale for continued anticoagulation; absent such rationale, code as history of rather than active.

Specify type: pulmonary embolism (PE) or deep vein thrombosis (DVT) and other specified site.
For PE: indicate acute vs chronic and whether acute cor pulmonale is present or absent.
State whether the event was provoked or unprovoked.
Document anticoagulation treatment: current status and exact length of treatment.
If treatment >3 months for PE (or beyond typical acute window for DVT), provide documented rationale; otherwise code as history (use Z79.0- / Z79.01 for long-term/current anticoagulant use as applicable).

Key definitions

DVT and PE — brief definitions

Deep vein thrombosis (DVT)A blood clot forming in the deep veins, usually in the legs.

Pulmonary embolism (PE)When a clot breaks off and travels to the lungs, blocking an artery.

Clinical distinctionDocumentation should note type (PE vs DVT) and acuity (acute vs chronic) to support accurate coding.

Long-term anticoagulation — coding and application

Primary long‑term anticoagulant codeZ79.01 — long-term (current) use of anticoagulants (use this additional code when applicable).

Alternate long‑term code formatZ79.0- — a dash indicates additional characters are required; use as appropriate for long‑term anticoagulant treatment coding.

When to applyUse Z79.01/Z79.0- to indicate ongoing anticoagulant therapy; if treatment extends beyond typical acute windows without clinical rationale, consider coding history rather than active disease.

Policy Summary

PayerIndependence Administrators

PolicyEmbolism and thrombosis — ICD-10 documentation and coding guidance

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMar 20, 2019

Next Review DateN/A

SourceLink

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Embolism and thrombosis — ICD-10 documentation and coding guidance

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Sign up for all independence_administrators policy alerts

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Documentation-driven coding criteria

Documentation and coding criteria to support coding decisions for embolism and thrombosis:

ALL of the following must be documented to code an active/current embolism or thrombosis

Type of event
- Pulmonary embolism (PE) — specify acute vs chronic, and whether with or without acute cor pulmonale
- Deep vein thrombosis (DVT) or other specified site — specify vein involved and laterality for chronic DVT coding (5th and 6th characters)
Acuity: document whether the event is acute or chronic (repeat radiologic studies confirming persistent clot > 4 weeks required to define chronic DVT)
Provoked vs unprovoked status of the event
Anticoagulation treatment: document current anticoagulant use and duration of therapy (document duration in your note)
Treatment rationale when duration exceeds usual acute windows: if treatment > 3 months for PE or > 6 months for DVT, include clear rationale why therapy is ongoing; otherwise code as history
If long-term anticoagulation is present
- Use Z79.0- or Z79.01 to indicate long-term (current) use of anticoagulants as applicable
- If anticoagulation extends beyond acute coding windows but is clearly clinically indicated, continue to code as acute/current with documentation of rationale

ICD-10 coding guidance

Covered/neutral ICD-10 codesICD-10

I26.99	Other pulmonary embolism without acute cor pulmonale
Z86.711	Personal history of pulmonary embolism
I82.432	Acute embolism and thrombosis of left popliteal vein
Z86.718	Personal history of other venous thrombosis and embolism
I82.5-	Chronic DVT codes (5th character for vein involved; 6th character for laterality)
I82.532	Chronic embolism and thrombosis left popliteal vein
Z79.01	Long-term (current) use anticoagulants

Acute PE coding window — up to 3 months

Documentation requirementDocument anticoagulation status and duration (note example: patient on anticoagulant two months into a three-month course).

Post‑3 month guidanceIf treatment extends beyond three months without documented clinical rationale, code as history rather than active disease.

Acute DVT coding window — up to 6 months

Documentation requirementDocument anticoagulation status and duration (note example: patient continues warfarin two months into a six-month course).

Post‑6 month guidanceIf treatment extends beyond six months without documented clinical rationale, consider coding as history rather than active disease unless clinically justified.

Chronic DVT definition — radiologic persistence >4 weeks

Chronic DVT thresholdChronic DVT is defined when repeat radiologic studies (ultrasound, CT, etc.) confirm persistent clot greater than four weeks.

Coding for chronic DVTUse I82.5- series for chronic DVT; specify 5th character for the vein involved and 6th character for laterality (right, left, bilateral, unspecified).

ExampleI82.532 — Chronic embolism and thrombosis of left popliteal vein (example usage).

Documentation requirements and actions for providers

Documentation Required

Required documentation elements for embolism/thrombosis coding

Specify type: pulmonary embolism (PE) or deep vein thrombosis (DVT) and other specified site.
For PE: indicate acute vs chronic and whether acute cor pulmonale is present or absent.
State whether the event was provoked or unprovoked.
Document anticoagulation treatment: current status and exact length of treatment.
If treatment >3 months for PE (or beyond typical acute window for DVT), provide documented rationale; otherwise code as history (use Z79.0- / Z79.01 for long-term/current anticoagulant use as applicable).

Key definitions

DVT and PE — brief definitions

Deep vein thrombosis (DVT)A blood clot forming in the deep veins, usually in the legs.

Pulmonary embolism (PE)When a clot breaks off and travels to the lungs, blocking an artery.

Clinical distinctionDocumentation should note type (PE vs DVT) and acuity (acute vs chronic) to support accurate coding.

Long-term anticoagulation — coding and application

Primary long‑term anticoagulant codeZ79.01 — long-term (current) use of anticoagulants (use this additional code when applicable).

Alternate long‑term code formatZ79.0- — a dash indicates additional characters are required; use as appropriate for long‑term anticoagulant treatment coding.