Coding Pulmonary Embolism – A Common Cardio-Vascular Disease

by | Last updated Jun 6, 2023 | Published on Sep 17, 2020 | Resources | 0 comments

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Regarded as one of the most common cardiovascular diseases in the United States, pulmonary embolism (PE) is a blockage in one of the pulmonary arteries in the lungs (which supplies blood to the lungs). The blockage prevents oxygen from reaching the tissues of the lungs. In most cases, the common cause of such blockage is a blood clot that occurs in a deep vein in the leg and travels to the lungs. The blood clot can damage part of the lung due to restricted blood flow, reduce oxygen levels in the blood and severely affect other organs in the body as well. If left untreated, pulmonary embolism can be life threatening – as large or multiple blood clots can be fatal. However, correct and timely treatment greatly reduces the risk of death. Diagnosing and reporting cardiovascular conditions can be challenging. Proper documentation is important to justify medical necessity and for selection of the right medical codes for billing purposes. Relying on the services of an experienced cardiology medical billing company can help in accurate and timely claim submission to insurers.

What Causes Pulmonary Embolism (PE)?

As mentioned above, the condition mainly occurs when a blood clot gets wedged into an artery in your lungs. These blood clots most commonly come from deep vein thrombosis (DVT) – a condition when blood clots form in veins deep in the body. The blood clots that most often cause pulmonary embolism begin in the legs or pelvis. In some cases, blockages in the blood vessels also occur due to other causes like – injury or damage (like bone fractures or muscle tears), sedentary lifestyle, fat from the marrow of a broken long bone, part of a tumor, air bubbles and certain medical conditions and related treatment modalities like chemotherapy for cancer or surgery. In addition, people have a high risk of developing such blockages if any of their family members have had venous blood clots or pulmonary embolism in the past.

What Are the Common Symptoms?

The signs and symptoms of PE can vary greatly and may depend on the size of the clot, where it lodges in the lung, and whether the patient has any underlying lung or heart disease. One of the most common symptoms of PE is shortness of breath – which may be gradual or sudden. Other additional symptoms include –

  • Weak pulse
  • Spitting up blood
  • Rapid breathing and heartbeat
  • Lightheadedness
  • Leg pain or swelling usually in the calf, or both
  • Fainting
  • Excessive sweating
  • Cough
  • Clammy or bluish skin
  • Chest pain that could extend to the arm, neck, jaw and shoulder
  • Anxiety and restlessness

It is important to get medical attention immediately if patients experience any of these symptoms.

Diagnosing and Treating PE

Generally, pulmonary embolism (PE) is quite difficult to diagnose, especially in people with an underlying lung or heart condition (such as emphysema or high blood pressure). As part of the diagnosis, physicians will conduct a detailed physical examination, medical history review and ask about the specific symptoms or underlying medical condition the patient suffers from. Diagnostic imaging tests like – blood tests, chest X-ray, Ultrasound, CT pulmonary angiography, Electrocardiography (ECG), Ventilation-perfusion scan (V/Q scan), pulmonary angiogram and MRI scan will be performed to discover the exact cause of symptoms.

Treatment for PE focuses on keeping the blood clot from getting bigger and preventing new clots from forming. Treatment modalities depend on the specific size and location of the blood clot. If the problem is minor and diagnosed at an early stage, cardiologists may recommend medication as the first-line treatment. Medications include different types of blood thinners (anticoagulants) and clot dissolvers (thrombolytics). In some cases, surgery may be essential to remove problematic blood clots, especially those that restrict blood flow to the lungs or heart. Surgical options include – clot removal, vein filter and open surgery. Cardiologists perform open surgery only in severe cases when medications and other surgical options are not effectively working to break up the clot.

Cardiology medical billing and coding can be challenging and involves using the relevant medical codes on the claims submitted to health insurers. Cardiologists or other specialists providing treatment (that involves diagnosis, screening and other tests) for PE patients must carefully document the diagnosis and treatments using the right medical codes. Billing and coding services offered by reputable medical billing companies can help physicians ensure the correct codes for their medical billing purposes. ICD-10 codes for pulmonary embolism include –

  • I26 Pulmonary embolism
  • I26.0 Pulmonary embolism with acute cor pulmonale
    • I26.01 Septic pulmonary embolism with acute cor pulmonale
    • I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
    • I26.09 Other pulmonary embolism with acute cor pulmonale
  • I26.9 Pulmonary embolism without acute cor pulmonale
    • I26.90 Septic pulmonary embolism without acute cor pulmonale
    • I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
    • I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
    • I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
    • I26.99 Other pulmonary embolism without acute cor pulmonale

A healthy lifestyle that gives prime focus to a healthy diet, regular physical activity and avoiding smoking can help prevent the risks of this condition. Regularly exercising your legs is a key component of therapy after a pulmonary embolism. A high risk patient can take anticoagulant medications, such as heparin and warfarin, to prevent blood clots from returning. In addition, patients need to use compression stockings (similar to really tight socks) or another device to prevent clots from forming in your legs. Compression methods are a good way to prevent blood clots by forcing blood into deep veins and reducing the amount of pooled blood.

Managing patients with pulmonary embolism can be quite challenging for cardiologists or other physicians. Outsourcing medical billing and coding tasks is a practical option for such physicians to ensure accurate clinical documentation of this cardio vascular condition and appropriate care for their patients.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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