ICD-10: I82.623

Acute embolism and thrombosis of deep veins of upper extremity, bilateral

Additional Information

Description

ICD-10 code I82.623 refers to "Acute embolism and thrombosis of deep veins of upper extremity, bilateral." This code is part of the broader classification for venous embolism and thrombosis, which encompasses various conditions affecting the venous system.

Clinical Description

Definition

Acute embolism and thrombosis of the deep veins of the upper extremities involve the obstruction of blood flow in the deep veins due to a blood clot (thrombus) or an embolus (a clot that has traveled from another location). When this condition occurs bilaterally, it affects both arms, leading to significant clinical implications.

Etiology

The primary causes of acute embolism and thrombosis in the deep veins of the upper extremities include:
- Venous stasis: Reduced blood flow due to prolonged immobility, such as during long flights or bed rest.
- Hypercoagulable states: Conditions that increase the tendency of blood to clot, which can be genetic or acquired (e.g., certain cancers, pregnancy, or hormonal therapies).
- Trauma or injury: Direct injury to the veins can lead to thrombosis.
- Catheter-related thrombosis: The presence of central venous catheters can irritate the vein and promote clot formation.

Symptoms

Patients with acute embolism and thrombosis of the deep veins of the upper extremities may present with:
- Swelling in the affected arms
- Pain or tenderness, particularly in the forearm or upper arm
- Changes in skin color, such as redness or a bluish tint
- Warmth in the affected area
- Possible signs of pulmonary embolism if the clot dislodges and travels to the lungs, which can include shortness of breath, chest pain, or coughing up blood.

Diagnosis

Diagnosis typically involves:
- Clinical evaluation: Assessment of symptoms and medical history.
- Imaging studies: Ultrasound is the most common non-invasive method to visualize clots in the deep veins. Other imaging techniques, such as CT venography, may also be used.
- D-dimer test: A blood test that can help rule out the presence of an abnormal blood clot.

Treatment

Management of acute embolism and thrombosis of the deep veins of the upper extremities may include:
- Anticoagulation therapy: Medications such as heparin or warfarin to prevent further clotting.
- Thrombolysis: In some cases, clot-dissolving medications may be administered.
- Compression therapy: Use of compression garments to reduce swelling and improve venous return.
- Surgical intervention: Rarely, surgical removal of the clot may be necessary, especially if there is a risk of pulmonary embolism.

Conclusion

ICD-10 code I82.623 captures a critical condition that requires prompt diagnosis and management to prevent complications. Understanding the clinical presentation, underlying causes, and treatment options is essential for healthcare providers to effectively address this serious health issue. Proper coding and documentation are vital for accurate billing and ensuring that patients receive appropriate care.

Clinical Information

The ICD-10 code I82.623 refers to "Acute embolism and thrombosis of deep veins of upper extremity, bilateral." This condition involves the obstruction of blood flow in the deep veins of both upper extremities due to a thrombus (blood clot) or an embolus (a clot that has traveled from another location). Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for accurate diagnosis and management.

Clinical Presentation

Definition and Pathophysiology

Acute embolism and thrombosis in the deep veins of the upper extremities can occur due to various factors, including prolonged immobility, trauma, or underlying medical conditions such as hypercoagulable states. The condition can lead to significant complications, including post-thrombotic syndrome and pulmonary embolism if the clot dislodges and travels to the lungs.

Signs and Symptoms

Patients with bilateral deep vein thrombosis (DVT) in the upper extremities may present with a range of signs and symptoms, including:

  • Swelling: One of the most common signs, often noticeable in both arms, particularly in the forearm and hand areas.
  • Pain or Tenderness: Patients may report pain that can vary from mild discomfort to severe pain, often described as a throbbing or aching sensation.
  • Skin Changes: The affected areas may exhibit discoloration, such as redness or a bluish tint, and may feel warm to the touch.
  • Reduced Range of Motion: Patients may experience difficulty moving their arms or hands due to pain and swelling.
  • Palpable Veins: In some cases, the affected veins may become engorged and can be felt as hard cords under the skin.

Additional Symptoms

In more severe cases, patients may experience systemic symptoms such as fever, chills, or malaise, which could indicate a more extensive thrombotic event or associated complications.

Patient Characteristics

Risk Factors

Certain patient characteristics and risk factors are associated with the development of bilateral upper extremity DVT, including:

  • Age: Older adults are at a higher risk due to age-related changes in vascular health.
  • Obesity: Increased body weight can contribute to venous stasis and increased pressure in the veins.
  • Medical History: A history of previous thromboembolic events, cancer, or chronic inflammatory diseases can predispose individuals to thrombosis.
  • Immobilization: Prolonged periods of immobility, such as during long flights or bed rest after surgery, can increase the risk of clot formation.
  • Hormonal Factors: Use of hormonal contraceptives or hormone replacement therapy can elevate the risk of thrombosis.
  • Genetic Predisposition: Conditions such as Factor V Leiden mutation or antiphospholipid syndrome can increase the likelihood of developing clots.

Demographics

While DVT can occur in any demographic, certain populations may be more susceptible. For instance, individuals with a sedentary lifestyle or those undergoing certain medical treatments (e.g., chemotherapy) may have a higher incidence of upper extremity DVT.

Conclusion

Acute embolism and thrombosis of the deep veins of the upper extremities, particularly when bilateral, is a serious condition that requires prompt recognition and management. Understanding the clinical presentation, including the signs and symptoms, as well as the patient characteristics and risk factors, is essential for healthcare providers to ensure timely diagnosis and treatment. Early intervention can significantly reduce the risk of complications and improve patient outcomes.

Approximate Synonyms

ICD-10 code I82.623 refers specifically to "Acute embolism and thrombosis of deep veins of upper extremity, bilateral." This code is part of a broader classification system used for diagnosing and billing purposes in healthcare. Below are alternative names and related terms associated with this condition.

Alternative Names

  1. Bilateral Upper Extremity Deep Vein Thrombosis (DVT): This term emphasizes the location (upper extremity) and the bilateral nature of the condition.
  2. Bilateral Upper Arm Venous Thrombosis: A more specific term that refers to thrombosis occurring in the veins of both arms.
  3. Bilateral Venous Embolism in Upper Limbs: This term highlights the embolic aspect of the condition, indicating that a clot has traveled to the veins of the upper limbs.
  1. Deep Vein Thrombosis (DVT): A general term for the formation of a blood clot in a deep vein, which can occur in various locations, including the legs and arms.
  2. Venous Thromboembolism (VTE): This broader term encompasses both deep vein thrombosis and pulmonary embolism, indicating the potential for clots to travel to the lungs.
  3. Acute Venous Thrombosis: A term that describes the sudden onset of thrombosis in any vein, including those in the upper extremities.
  4. Embolism: Refers to the obstruction of a blood vessel by a clot or other material that has traveled from another location in the body.
  5. Thrombosis: The formation of a blood clot within a blood vessel, which can lead to obstruction of blood flow.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in diagnosis, treatment, and billing processes. Accurate terminology ensures proper communication among medical staff and aids in the effective management of patients with this condition.

In summary, ICD-10 code I82.623 is associated with various alternative names and related terms that reflect the nature and location of the condition. These terms are essential for clinical documentation and facilitate a better understanding of the patient's diagnosis and treatment options.

Diagnostic Criteria

The ICD-10 code I82.623 refers to "Acute embolism and thrombosis of deep veins of upper extremity, bilateral." This diagnosis is associated with specific clinical criteria and considerations that healthcare providers must evaluate to ensure accurate coding and appropriate patient management. Below are the key criteria and considerations for diagnosing this condition.

Clinical Criteria for Diagnosis

1. Symptoms and Clinical Presentation

  • Swelling: Patients may present with unilateral or bilateral swelling of the upper extremities, which can be a sign of deep vein thrombosis (DVT).
  • Pain: Localized pain in the arm or shoulder, often described as a heaviness or aching sensation.
  • Skin Changes: Changes in skin color (e.g., redness or pallor) and temperature differences between the affected and unaffected limbs.
  • Functional Impairment: Reduced range of motion or difficulty using the affected arm due to pain or swelling.

2. Diagnostic Imaging

  • Ultrasound: A non-invasive peripheral venous ultrasound is typically performed to visualize the deep veins of the upper extremity. This imaging can confirm the presence of thrombus (blood clot) in the veins.
  • Doppler Studies: These may be used to assess blood flow and detect any occlusions in the deep veins.

3. Risk Factors Assessment

  • History of Thrombosis: Previous episodes of DVT or pulmonary embolism can increase the likelihood of acute embolism and thrombosis.
  • Recent Surgery or Trauma: Surgical procedures, particularly those involving the upper extremities, or trauma can predispose patients to thrombotic events.
  • Immobilization: Prolonged periods of immobility, such as long flights or bed rest, can contribute to the development of DVT.
  • Underlying Conditions: Conditions such as cancer, heart disease, or clotting disorders may also be relevant.

4. Laboratory Tests

  • D-dimer Test: Elevated levels of D-dimer can indicate the presence of an abnormal blood clot, although this test is not specific and must be interpreted in conjunction with clinical findings and imaging results.

Coding Considerations

When coding for I82.623, it is essential to ensure that the diagnosis is supported by the clinical findings and diagnostic tests. The following points should be noted:

  • Bilateral Diagnosis: The code specifically indicates that the embolism and thrombosis are bilateral, meaning both upper extremities are affected. Documentation must reflect this bilateral involvement.
  • Acute Nature: The term "acute" signifies that the condition has developed recently, which is crucial for accurate coding and treatment planning.
  • Comorbidities: If the patient has other conditions that may affect the treatment or management of the thrombosis, these should also be documented and coded appropriately.

Conclusion

In summary, the diagnosis of acute embolism and thrombosis of the deep veins of the upper extremity, bilateral (ICD-10 code I82.623), requires a comprehensive evaluation of clinical symptoms, diagnostic imaging, risk factors, and laboratory tests. Accurate documentation and coding are essential for effective patient management and reimbursement processes. Healthcare providers should ensure that all relevant information is captured to support the diagnosis and facilitate appropriate treatment strategies.

Treatment Guidelines

Acute embolism and thrombosis of the deep veins of the upper extremity, classified under ICD-10 code I82.623, is a serious condition that requires prompt and effective treatment. This condition typically involves the formation of a blood clot in the deep veins of the arms, which can lead to complications such as post-thrombotic syndrome or pulmonary embolism if not managed appropriately. Below is an overview of standard treatment approaches for this condition.

Initial Assessment and Diagnosis

Before treatment can begin, a thorough assessment is essential. This typically includes:

  • Clinical Evaluation: A detailed history and physical examination to assess symptoms such as swelling, pain, and discoloration in the affected limbs.
  • Imaging Studies: Doppler ultrasound is the primary imaging modality used to confirm the presence of a thrombus in the deep veins. In some cases, CT venography may be utilized for a more comprehensive view[1].

Standard Treatment Approaches

1. Anticoagulation Therapy

The cornerstone of treatment for acute deep vein thrombosis (DVT) is anticoagulation therapy. This helps to prevent the clot from growing and reduces the risk of pulmonary embolism. Common anticoagulants include:

  • Low Molecular Weight Heparin (LMWH): Such as enoxaparin, which is often administered subcutaneously.
  • Direct Oral Anticoagulants (DOACs): Medications like rivaroxaban or apixaban may be used as alternatives to LMWH after initial treatment.
  • Warfarin: This may be initiated in conjunction with LMWH and continued for a longer duration, depending on the patient's risk factors and response to therapy[2][3].

2. Thrombolytic Therapy

In cases of extensive thrombosis or when there is a significant risk of complications, thrombolytic therapy may be considered. This involves the administration of medications that dissolve clots, such as tissue plasminogen activator (tPA). This treatment is typically reserved for severe cases due to the associated risks of bleeding[4].

3. Mechanical Interventions

For patients who do not respond to anticoagulation or thrombolytic therapy, or in cases of severe symptoms, mechanical interventions may be necessary:

  • Thrombectomy: This surgical procedure involves the removal of the clot from the vein and may be performed in conjunction with thrombolysis.
  • Inferior Vena Cava (IVC) Filters: In patients with recurrent embolism despite anticoagulation, an IVC filter may be placed to prevent clots from reaching the lungs[5].

4. Supportive Care

Supportive measures are also crucial in managing symptoms and preventing complications:

  • Compression Therapy: Graduated compression stockings can help reduce swelling and improve venous return.
  • Pain Management: Analgesics may be prescribed to manage pain associated with the condition.
  • Physical Therapy: Early mobilization and physical therapy can help improve circulation and prevent complications related to immobility[6].

Follow-Up and Monitoring

Regular follow-up is essential to monitor the effectiveness of treatment and to adjust anticoagulation dosages as necessary. Patients should be educated about the signs of potential complications, such as recurrent thrombosis or pulmonary embolism, and advised to seek immediate medical attention if symptoms arise.

Conclusion

The management of acute embolism and thrombosis of the deep veins of the upper extremity, particularly when bilateral, involves a multifaceted approach that includes anticoagulation, potential thrombolytic therapy, mechanical interventions, and supportive care. Early diagnosis and treatment are critical to improving outcomes and preventing serious complications. Continuous monitoring and patient education play vital roles in the long-term management of this condition.


References

  1. National Coding Advice.
  2. Medicare Claims Processing Manual.
  3. Billing and Coding: Non-Invasive Peripheral Venous Studies.
  4. Final Draft Report Thromboembolic Event Case Algorithms.
  5. Concordance of Identified Cases of Pediatric HA-VTE with ...
  6. Venous Duplex Ultrasound of the Upper Extremities.

Related Information

Description

  • Obstruction of blood flow due to clot or embolus
  • Condition occurs bilaterally affecting both arms
  • Venous stasis causes reduced blood flow and clot formation
  • Hypercoagulable states increase tendency of blood to clot
  • Trauma or injury leads to direct vein irritation
  • Catheter-related thrombosis promotes clot formation
  • Swelling, pain, changes in skin color, warmth in affected area
  • Possible signs of pulmonary embolism if clot dislodges
  • Anticoagulation therapy prevents further clotting
  • Thrombolysis dissolves clots in some cases
  • Compression therapy reduces swelling and improves venous return

Clinical Information

Approximate Synonyms

  • Bilateral Upper Extremity DVT
  • Bilateral Upper Arm Venous Thrombosis
  • Bilateral Venous Embolism in Upper Limbs
  • Deep Vein Thrombosis (DVT)
  • Venous Thromboembolism (VTE)
  • Acute Venous Thrombosis
  • Embolism
  • Thrombosis

Diagnostic Criteria

  • Unilateral or bilateral swelling of upper extremities
  • Localized pain in arm or shoulder
  • Skin color changes (redness or pallor)
  • Temperature differences between affected limbs
  • Reduced range of motion or functional impairment
  • Presence of thrombus confirmed by ultrasound
  • Blood flow assessment with Doppler studies
  • History of previous thrombosis or pulmonary embolism
  • Recent surgery or trauma involving upper extremities
  • Prolonged immobilization or bed rest
  • Underlying conditions such as cancer or heart disease

Treatment Guidelines

  • Anticoagulation therapy is primary treatment
  • Low Molecular Weight Heparin (LMWH) used subcutaneously
  • Direct Oral Anticoagulants (DOACs) alternatives to LMWH
  • Warfarin initiated in conjunction with LMWH
  • Thrombolytic therapy for severe cases or complications
  • Mechanical interventions for non-response to anticoagulation
  • Thrombectomy surgical procedure to remove clot
  • Inferior Vena Cava (IVC) filters prevent clots reaching lungs
  • Compression therapy reduce swelling and improve circulation
  • Pain management with analgesics to manage pain
  • Physical therapy improve circulation and prevent complications

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