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JustCoding News: Inpatient, June 20, 2012

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How do you code from an OP Doppler study of extremity: A diagnosis of "mild occlusive artery of lower extremity" or mild occlusion of lower extremity artery? Do you assume this is embolus/thrombus and code to 444.22 as the index leads? There was no follow-up related to an embolus or thrombus.

We later asked the radiologist and he said there was no documentation of thrombus. Would we need to have him document "without embolus/thrombus" in order to code the 440.20?

Coding Clinic March-April 1987 says, “Occlusion presumes an embolism or thrombosis or an occlusion of peripheral artery not further qualified.” It also says that occlusive peripheral arterial disease with no evidence of thrombus or embolus and not described as "acute" is coded according to the presumed etiology included in the related statement of diagnosis.

The Index entry:
Disease
Arterial 447.9
Occlusive (see also Occlusion by site) 444.22

Occlusion
Arteries of extremity, lower 444.22

When the coder verifies the code in the Tabular List, Category 444 Arterial embolism and thrombosis Includes: Occlusion

Note: All three are consistent and lead to the same conclusion:

  • Index: Selection of essential modifiers in the diagnostic statement
  • Coding Clinic guideline: "Occlusion presumes an embolism or thrombosis"
  • Tabular List: Arterial embolism and thrombosis includes occlusion
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