Effective October 1, 2009, a new code (416.2) has been created to describe chronic pulmonary embolism to distinguish between patients who are being treated for an acute pulmonary embolism and patients with chronic pulmonary embolism who are being maintained on anticoagulant therapy for an extended period of time. Previously the classification did not differentiate between acute and chronic pulmonary embolism.
An embolus is a blood clot that most commonly originates in the veins of the legs (deep vein thrombosis). The blood clot can dislodge and travel as an embolus to other organs in the body. A pulmonary embolism is a clot that lodges in the lungs, blocking the pulmonary arteries and reducing blood flow to a region of the lungs.
Pulmonary embolic disease may be acute or chronic (longstanding, having occurred over many weeks, months or years). In the majority of cases acute pulmonary emboli do not cause chronic disease because the body's mechanisms will usually break down the blood clot. An acute embolus is usually treated with anticoagulants (e.g., intravenous heparin and warfarin or oral Coumadin) to dissolve the clot and prevent new ones.
For acute pulmonary embolism, anticoagulant therapy may be carried out for 3 to 6 months. Therapy is discontinued when the embolus dissolves. However, it can persist. In patients with recurrent pulmonary embolic disease while on blood thinners or patients who cannot tolerate blood thinners, a filter can be placed to interrupt the vena cava. The device filters the blood returning to the heart and lungs. In some cases of chronic pulmonary embolism, the clot develops fibrous tissue, and surgery is needed to remove this fibrous tissue.
Thrombolytic therapy (e.g., streptokinase, urokinase, and tissue plasminogen activator) is another treatment option for acute pulmonary embolism. However, thrombolytics are generally contraindicated in patients that are pregnant, have had a recent cerebrovascular accident, have a bleeding disorder, or have had recent surgery.
Code 415.19, Pulmonary embolism and infarct, Other, is used for an acute pulmonary embolism. There is no specific timeframe that distinguishes acute from chronic pulmonary embolism. These codes should be assigned on the basis of the provider's documentation. Query the provider for clarification if the documentation is unclear.
415 Acute pulmonary heart disease 415.1 Pulmonary embolism and infarction Add Excludes: chronic pulmonary embolism (416.2) Add personal history of pulmonary embolism (V12.51) 416 Chronic pulmonary heart disease New code 416.2 Chronic pulmonary embolism Use additional code, if applicable, for associated long-term (current) use of anticoagulants (V58.61) Excludes: personal history of pulmonary embolism (V12.51)