I82.412

Acute embolism and thrombosis of left femoral vein

Acute embolism and thrombosis of the left femoral vein is a serious clinical condition characterized by the sudden formation of a blood clot (thrombus) within the deep femoral vein of the left lower extremity. This condition falls under the broader category of Deep Vein Thrombosis (DVT). The 'acute' classification specifically refers to a thrombus that has formed recently, typically within the last 14 days, during which the clot is poorly attached to the venous wall and has a high propensity for fragmentation or dislodgement. The femoral vein is a major deep vessel responsible for returning deoxygenated blood from the leg to the heart. If a portion of the clot breaks free, it becomes an embolus, which can travel through the venous system and right heart chambers into the pulmonary arteries, causing a life-threatening pulmonary embolism (PE). Clinical presentation usually involves unilateral symptoms in the left leg, and diagnosis is primarily confirmed via venous duplex ultrasonography. Treatment typically requires immediate initiation of anticoagulation therapy to prevent further clot propagation, reduce the risk of embolization, and minimize the risk of developing long-term complications like post-thrombotic syndrome (PTS).

Clinical Symptoms

  • Unilateral swelling (edema) of the left leg, often most prominent in the thigh
  • Persistent aching, cramping, or deep muscle pain in the left leg or groin
  • Localized tenderness along the course of the left femoral vein
  • Noticeable warmth in the left leg compared to the contralateral limb
  • Erythema or bluish-purple discoloration of the skin on the left leg
  • Distension of superficial veins on the surface of the leg
  • Pain or discomfort that worsens with walking or weight-bearing
  • Pitting edema in the left ankle or calf
  • Diminished pulses in the foot if swelling is severe enough to cause compartment-like pressure (rare)
  • Low-grade fever associated with the inflammatory response of the vein

Common Causes

  • Venous stasis resulting from prolonged immobility (e.g., long-distance travel, bed rest)
  • Vascular endothelial injury due to recent surgery, especially left hip or knee arthroplasty
  • Physical trauma or fracture of the left femur or pelvic bones
  • Malignancy and paraneoplastic syndromes that induce a prothrombotic state
  • Genetic hypercoagulability (e.g., Factor V Leiden, Prothrombin G20210A mutation)
  • Acquired hypercoagulable states such as Antiphospholipid Syndrome
  • Oral contraceptive use or Hormone Replacement Therapy (HRT)
  • Pregnancy or the immediate postpartum period due to hormonal changes and venous compression
  • Advanced age (significantly increasing risk over age 60)
  • Obesity (Body Mass Index over 30 kg/m2)
  • History of smoking which contributes to endothelial dysfunction

Documentation & Coding Tips

Explicitly define the temporal status as acute to distinguish from chronic or history of venous thromboembolism.

Example: Patient presents with acute onset of left lower extremity edema and tenderness. Duplex ultrasound confirms acute occlusive thrombus in the left common femoral vein. This acute embolism and thrombosis of the left femoral vein requires immediate initiation of therapeutic anticoagulation to prevent pulmonary embolism.

Billing Focus: Specifying acute vs chronic status directly impacts the ICD-10-CM code selection between I82.412 and I82.512.

Identify the specific vein involved with anatomical precision to avoid unspecified location codes.

Example: Clinical evaluation and venous duplex imaging of the left leg demonstrate acute thrombosis of the left femoral vein. Thrombus is visualized extending from the mid-thigh to the distal femoral segment. No involvement of the popliteal or iliac veins noted at this time.

Billing Focus: Documentation of the femoral vein specifically supports I82.41x series; specifying the left side provides the 6th digit specificity of 2.

Clearly document the laterality of the affected limb as left, right, or bilateral.

Example: Physical exam reveals unilateral 3+ pitting edema of the left calf and thigh. Ultrasound confirms acute embolism and thrombosis of the left femoral vein. The right lower extremity remains asymptomatic with negative imaging.

Billing Focus: Laterality is a mandatory documentation element for I82.412; lack of laterality results in the use of I82.419, which is often rejected by payers.

Document clinical manifestations such as pain, swelling, or redness to support medical necessity for diagnostic testing.

Example: Patient reports sharp pain in the left groin and calf, exacerbated by ambulation. Objective findings include warmth and 4cm circumference discrepancy in the left thigh compared to the right. Diagnosed with acute embolism and thrombosis of the left femoral vein.

Billing Focus: Symptom documentation justifies the medical necessity of CPT 93970 or 93971 ultrasound procedures.

State if the DVT is provoked by a transient risk factor like surgery or unprovoked.

Example: Acute embolism and thrombosis of the left femoral vein diagnosed 5 days post-operative following left total hip arthroplasty. This is considered a provoked acute DVT secondary to recent major orthopedic surgery and immobility.

Billing Focus: Identifying the cause (e.g., post-procedural) may require additional external cause codes for a complete billing profile.

Relevant CPT Codes

Related Diagnoses

Hierarchy