I82

Embolism and thrombosis of other veins

Embolism and thrombosis of other veins (I82) is a clinical category encompassing venous thromboembolic events (VTE) that occur outside the portal system and primary superficial phlebitis. This category includes high-acuity conditions such as Budd-Chiari syndrome (hepatic vein obstruction), renal vein thrombosis, and both acute and chronic deep vein thrombosis (DVT) of the lower and upper extremities. These conditions are characterized by the formation of an intravascular blood clot (thrombus) that may obstruct blood flow or detach and travel to the lungs as a pulmonary embolism. The clinical significance ranges from localized pain and swelling to life-threatening organ dysfunction or systemic embolism, requiring careful diagnostic imaging and anticoagulation management.

Clinical Symptoms

  • Localized edema (swelling) of the affected limb or region
  • Erythema (redness) and warmth over the thrombosed vein
  • Tenderness or pain along the venous path
  • Visible distension of superficial collateral veins
  • Phlegmasia cerulea dolens (severe blue discoloration in massive DVT)
  • Abdominal or flank pain (characteristic of visceral or renal vein thrombosis)
  • Hepatomegaly and ascites (characteristic of hepatic vein thrombosis)
  • Hematuria (in the context of renal vein involvement)
  • Dyspnea or chest pain (if secondary pulmonary embolism occurs)

Common Causes

  • Endothelial injury from trauma, surgery, or indwelling venous catheters
  • Venous stasis due to prolonged immobilization, obesity, or heart failure
  • Malignancy (paraneoplastic hypercoagulability)
  • Inherited thrombophilias such as Factor V Leiden or Prothrombin G20210A mutation
  • Deficiencies in Protein C, Protein S, or Antithrombin III
  • Acquired hypercoagulable states including Antiphospholipid Syndrome
  • Pregnancy and the postpartum period
  • Use of oral contraceptives or hormone replacement therapy
  • Nephrotic syndrome (specifically increasing risk for renal vein thrombosis)

Documentation & Coding Tips

Distinguish between acute and chronic embolism or thrombosis to ensure precise ICD-10-CM selection.

Example: Patient presents with acute onset right-sided flank pain. Imaging confirms acute embolism and thrombosis of the right renal vein. History is negative for prior venous thromboembolism. Plan: Initiate systemic anticoagulation. Billing Focus: Identification of acute status and specific renal vein involvement. Risk Adjustment: Maps to HCC 108 for acute vascular disease, reflecting higher severity than chronic or non-specific conditions.

Billing Focus: Specifying the acute vs. chronic nature is mandatory for 4th and 5th character specificity in the I82 category.

Document the specific vein involved with anatomical precision to avoid the use of unspecified codes.

Example: Evaluation of a 55-year-old male with new-onset ascites. Doppler ultrasound reveals acute embolism and thrombosis of the hepatic vein, consistent with Budd-Chiari syndrome. No evidence of inferior vena cava involvement. Billing Focus: Anatomical site specificity (Hepatic vein). Risk Adjustment: Budd-Chiari (I82.0) is a high-acuity condition requiring intensive management, impacting medical necessity and risk scores.

Billing Focus: Anatomical specificity (e.g., SVC, IVC, renal, hepatic) is required to move beyond the general I82.90 code.

Explicitly state the presence or absence of associated complications such as infarction or organ failure.

Example: Acute embolism and thrombosis of the superior vena cava secondary to indwelling central venous catheter, resulting in SVC syndrome. Patient exhibits facial edema and venous distention. Billing Focus: Inclusion of SVC syndrome as a complication. Risk Adjustment: Presence of complications like SVC syndrome increases the complexity of the medical decision-making (MDM) and mortality risk assessment.

Billing Focus: Documenting complications supports the highest level of medical necessity for interventional procedures.

Clarify the laterality for paired venous structures like renal or iliac veins.

Example: Left renal vein thrombosis, acute, confirmed via CT angiography. Right renal vein remains patent. Patient has associated nephrotic syndrome. Billing Focus: Laterality (Left). Risk Adjustment: Laterality is often required for specific ICD-10-CM codes that map to different risk-adjusted categories or DRG weights in inpatient settings.

Billing Focus: ICD-10-CM specificity for renal veins (I82.3) requires identifying right vs. left.

Note the underlying etiology if known, such as malignancy-induced hypercoagulability or mechanical causes.

Example: Acute embolism and thrombosis of the inferior vena cava, infrarenal segment, likely secondary to compression by retroperitoneal mass (metastatic adenocarcinoma). Billing Focus: Identification of the thrombus as acute and the specific IVC segment. Risk Adjustment: Linking the thrombosis to an underlying malignancy identifies a high-risk comorbid state (MCC) in many payment models.

Billing Focus: Documenting the cause (e.g., neoplasm, catheter-related) provides clinical context that may support secondary coding.

Relevant CPT Codes

Related Diagnoses

Hierarchy