FAQ about Phlebitis and Related ICD-10 Codes

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Phlebitis refers to a condition that typically occurs due to the inflammation of a vein. Veins are blood vessels that carry blood from your limbs and other organs of the body back to your heart. Inflammation of the vein occurs when there is a blood clot or damage inside the walls of the vein. The inflammation may cause severe pain and swelling. If a blood clot is causing an inflammation, it is called thrombophlebitis. When the blood clot occurs in deep vein, it is known as deep vein thrombophlebitis, or deep vein thrombosis (DVT). In most cases, phlebitis affects people aged 40-60 years. However, toddlers, children, preteens, and people in the age group of 14 – 16 years can also suffer from this condition. Physician specialists treating this condition need to correctly document the same in the patient medical records. Opting for outsourced billing services from a reliable provider can help simplify the documentation process.

Here are some frequently asked questions and answers about phlebitis –

What causes phlebitis?

An injury or irritation to the lining of a blood vessel is one of the factors that cause phlebitis. Other related causes include – prolonged inactivity (like long driving or plane rides), placement of an IV catheter, varicose veins, underlying cancers or clotting disorders and intravenous drug usage.

What are the different types of phlebitis?

Phlebitis is of two different types, which can be either superficial or deep. Typically, not a serious condition, superficial phlebitis occurs due to the inflammation of a vein near the surface of your skin. It can also result from a blood clot or due to irritation like an intravenous (IV) catheter and usually resolves with treatment options like warm compresses and anti-inflammatory medications. Deep phlebitis, on the other hand, refers to inflammation of a deeper, larger vein (those found in the arms or legs) caused by a blood clot. Blood clots (thrombi) that form may embolize or break off and travel to the lungs.

What are the signs and symptoms of phlebitis?

Generally, people with phlebitis experience no specific symptoms. It is estimated that only half of the people who develop this condition experience symptoms. This is in fact, one of the primary reasons why phlebitis may not be diagnosed until a serious complication (like a pulmonary embolism) occurs. Some of the other common symptoms include - pain, tenderness, redness, and a bulging vein, painful hard lumps underneath the skin, visible red “streaking” on your arm or leg and rope- or cord-like structure that you can feel through the skin. The pain may become more intense or noticeable when walking or flexing your foot.

What are the potential risks and complications related to this condition?

Identifying the exact risk factors is important to protect a patient suffering from this disorder. Some of the common risk factors include – age (above 60 years), obesity, smoking and alcohol consumption, pregnancy, prolonged periods of inactivity, family history of blood clotting disorders and hormone therapy or birth control pills. Usually, people are not aware about the complications associated with the condition. If undiagnosed and untreated at the right time, the condition can lead to severe complications like infection of the surrounding skin, wounds on the skin, and even bloodstream infections. One of the most common and serious complications of DVT is a PE. A PE occurs when a piece of the blood clot breaks off and travels to the lungs, thereby blocking the blood flow.

How is phlebitis diagnosed?

Diagnosis of the condition is based on a detailed examination and evaluation of symptoms. If an occurrence of a blood clot is suspected as the cause of phlebitis, physicians perform several additional tests like - ultrasound of the affected limb that uses sound waves to show the flow of blood through the veins and arteries. Physicians may also assess d-dimer level – wherein the blood will be tested to check for a substance released in the body when a clot dissolves. However, if the ultrasound doesn’t provide a clear answer, physicians may also suggest performing Venography, CT scan, or MRI scan to check for the presence of a blood clot. If a clot in the blood is detected, physicians may take samples of the blood to test for any specific blood clotting disorders.

How is phlebitis treated and documented?

Treatment modalities for phlebitis generally depend on the location, extent, symptoms, and underlying medical conditions. In case of superficial phlebitis, treatment options include applying warm compresses, elevation of the involved extremity, encouraging ambulation (walking) and anti-inflammatory medications (such as ibuprofen). External compression with fitted stockings is also a recommended option for patients with superficial phlebitis of the lower extremities. On the other hand, for patients with extensive deep vein thrombosis (DVT), treatment involves a procedure called a thrombectomy – wherein a surgeon inserts a wire and catheter into the affected vein and either removes the clot or dissolves it with medications or performs a combination of both these procedures. For people who experience a DVT and are at high risk for pulmonary embolism (but can’t take blood thinners) - insertion of a filter into one of the major blood vessels, the vena cava, may be recommended. This will not only prevent blood clots from forming, but will also prevent pieces of the clot from traveling to the lungs. In most cases, these filters are removable as permanent filters can cause severe complications like – infections, damage to the vena cava and enlargement of blood vessels around the filter after being placed for one to two years.

What ICD-10 codes are used for diagnosing phlebitis?

Physicians treating patients with phlebitis must use the correct codes to document the diagnosis, screening and other procedures performed.  

         I80 Phlebitis and thrombophlebitis

         I80.0 Phlebitis and thrombophlebitis of superficial vessels of lower extremities

I80.00 Phlebitis and thrombophlebitis of superficial vessels of unspecified lower extremity

         I80.1 Phlebitis and thrombophlebitis of femoral vein

I80.10 Phlebitis and thrombophlebitis of unspecified femoral vein

         I80.2 Phlebitis and thrombophlebitis of other and unspecified deep vessels of lower extremities

•  I80.20 Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities
•  I80.21 Phlebitis and thrombophlebitis of iliac vein
• I80.22 Phlebitis and thrombophlebitis of popliteal vein
• I80.23 Phlebitis and thrombophlebitis of tibial vein
• I80.24 Phlebitis and thrombophlebitis of peroneal vein
• I80.25 Phlebitis and thrombophlebitis of calf muscular vein
• I80.29 Phlebitis and thrombophlebitis of other deep vessels of lower extremities

         I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified

         I80.8 Phlebitis and thrombophlebitis of other sites

         I80.9 Phlebitis and thrombophlebitis of unspecified site

What are the possible ways to prevent phlebitis?

Incorporating simple measures can help prevent the formation of blood clots and reduce the risk of the condition in the long run. Some key prevention strategies include -

·         Discussing risk factors associated with the condition, with the physician especially prior to a surgical procedure

·         Wearing compression socks
·         Taking medications as instructed by the physician         
·         Stretching legs
·         Early mobilization after surgery

What is the long-term outlook for people with phlebitis?

The long-term outlook for people with phlebitis is generally positive. Superficial phlebitis, in most cases heals without lasting effects. Deep vein thrombosis (DVT) on the other hand can be life-threatening and requires immediate medical attention. Therefore, it is important for patients to have a clear idea about the associated risk factors of the condition and receive regular medical attention.

Billing and coding for vein blood clotting disorders can be challenging as it requires the right knowledge regarding the modifiers and payer-specific billing for correct and on-time reimbursement. With all the complexities involved, outsourcing medical billing and coding services to a reliable and experienced provider would prove useful to report phlebitis correctly.