ICD-10: I87.313

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity is classified under the ICD-10 code I87.313. This condition is characterized by increased pressure in the venous system of the legs, leading to various complications, including the development of ulcers. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description

Definition

Chronic venous hypertension refers to a condition where there is sustained elevated pressure in the venous system, particularly in the lower extremities. This condition can lead to venous insufficiency, where the veins are unable to effectively return blood to the heart, resulting in pooling of blood in the legs. The idiopathic classification indicates that the exact cause of the hypertension is unknown, distinguishing it from secondary causes such as deep vein thrombosis or other vascular diseases.

Symptoms

Patients with chronic venous hypertension may experience a range of symptoms, including:
- Swelling in the legs and ankles, particularly after prolonged standing or sitting.
- Pain or heaviness in the legs, which may worsen throughout the day.
- Skin changes, such as discoloration or thickening of the skin.
- Development of venous ulcers, which are open sores that can occur due to the breakdown of skin tissue from prolonged venous pressure.

Ulcer Characteristics

The ulcers associated with chronic venous hypertension are typically located on the lower extremities, particularly around the ankles. They may present as:
- Shallow, irregularly shaped wounds.
- Surrounding skin that appears red, swollen, or discolored.
- Exudate or drainage from the ulcer, which can be serous or purulent.

Diagnosis

Diagnosis of chronic venous hypertension with ulcers involves a combination of clinical evaluation and diagnostic imaging. Key components include:
- Patient History: Assessment of symptoms, duration, and any previous venous issues.
- Physical Examination: Inspection of the legs for swelling, skin changes, and the presence of ulcers.
- Ultrasound: Doppler ultrasound may be used to evaluate venous flow and identify any underlying venous insufficiency or obstruction.

Treatment

Management of chronic venous hypertension with ulcers typically involves a multidisciplinary approach, including:
- Compression Therapy: Use of compression stockings or bandages to improve venous return and reduce swelling.
- Wound Care: Proper care of ulcers to promote healing, which may include debridement, topical treatments, and dressings.
- Medications: Use of medications to manage pain and inflammation, as well as to improve venous tone.
- Surgical Options: In some cases, surgical interventions may be necessary to address underlying venous issues, such as varicose veins or venous reflux.

Prognosis

The prognosis for patients with chronic venous hypertension and ulcers can vary based on the severity of the condition and the effectiveness of treatment. Early intervention and adherence to treatment protocols can significantly improve outcomes and reduce the risk of complications, such as recurrent ulcers or infections.

In summary, ICD-10 code I87.313 encapsulates a significant health issue that requires comprehensive management to alleviate symptoms and promote healing. Understanding the clinical aspects of this condition is crucial for healthcare providers in delivering effective care to affected patients.

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity, classified under ICD-10 code I87.313, is a condition characterized by increased pressure in the venous system of the legs, leading to various clinical manifestations. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for effective diagnosis and management.

Clinical Presentation

Chronic venous hypertension occurs when the veins in the legs are unable to efficiently return blood to the heart, resulting in elevated venous pressure. This condition can lead to the development of venous ulcers, particularly in the lower extremities. The clinical presentation typically includes:

• Bilateral Lower Extremity Ulcers: These are often located around the ankles and may vary in size and depth. The ulcers are usually shallow with irregular borders and may have a yellowish or necrotic base.
• Skin Changes: Patients may exhibit changes in skin color (hyperpigmentation), thickening of the skin (lipodermatosclerosis), and the presence of eczema or dermatitis around the ulcer site.

Signs and Symptoms

The signs and symptoms of chronic venous hypertension with ulcers can be quite pronounced and may include:

• Swelling (Edema): Patients often experience swelling in the legs, particularly after prolonged standing or sitting. This swelling may improve with elevation of the legs.
• Pain or Discomfort: Patients may report aching, heaviness, or cramping in the legs, which can worsen throughout the day.
• Itching or Burning Sensation: The affected areas may be itchy or have a burning sensation, particularly around the ulcer sites.
• Varicose Veins: The presence of varicose veins is common, which may be visible as enlarged, twisted veins under the skin.
• Infection Signs: In some cases, ulcers may become infected, leading to increased redness, warmth, and discharge.

Patient Characteristics

Certain patient characteristics may predispose individuals to chronic venous hypertension and the development of ulcers:

• Age: Older adults are more commonly affected due to the natural weakening of vein walls and valves over time.
• Obesity: Increased body weight can contribute to venous pressure and exacerbate symptoms.
• Sedentary Lifestyle: Prolonged periods of inactivity can lead to poor venous return and increased venous pressure.
• History of Venous Disease: A personal or family history of venous insufficiency or varicose veins increases the risk.
• Previous Venous Thrombosis: A history of deep vein thrombosis (DVT) can lead to post-thrombotic syndrome, which may result in chronic venous hypertension.

Conclusion

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity is a significant health concern that requires careful assessment and management. Recognizing the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is essential for healthcare providers to implement appropriate treatment strategies. Early intervention can help prevent complications and improve the quality of life for affected individuals.

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity, represented by the ICD-10 code I87.313, is a specific medical condition characterized by increased pressure in the venous system of the legs, leading to ulcers. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with this condition.

Alternative Names

1. Chronic Venous Insufficiency (CVI): This term is often used interchangeably with chronic venous hypertension, as both conditions involve impaired venous return and can lead to similar symptoms, including ulcers.

2. Venous Ulcer: This term specifically refers to the ulcers that develop due to chronic venous hypertension, highlighting the ulcerative aspect of the condition.

3. Venous Stasis Ulcer: This name emphasizes the role of venous stasis (pooling of blood in the veins) in the development of ulcers, which is a common complication of chronic venous hypertension.

4. Idiopathic Chronic Venous Hypertension: This is a more descriptive term that specifies the idiopathic nature of the condition, indicating that the exact cause of the hypertension is unknown.

5. Bilateral Venous Ulcers: This term focuses on the bilateral aspect of the ulcers, indicating that they occur on both lower extremities.

Related Terms

1. ICD-10 Codes: Other related ICD-10 codes include:
   - I87.312: Chronic venous hypertension (idiopathic) with ulcer of right lower extremity.
   - I87.311: Chronic venous hypertension (idiopathic) with ulcer of left lower extremity.

2. Chronic Venous Disease (CVD): This broader term encompasses various conditions affecting the venous system, including chronic venous hypertension and its complications.

3. Varicose Veins: While not synonymous, varicose veins are often associated with chronic venous hypertension and can contribute to the development of ulcers.

4. Peripheral Vascular Disease (PVD): This term refers to diseases affecting blood vessels outside the heart and brain, which can include venous conditions.

5. Skin Ulcer: A general term that can refer to any ulcer on the skin, including those caused by venous hypertension.

Conclusion

Understanding the alternative names and related terms for ICD-10 code I87.313 is crucial for accurate diagnosis, treatment, and billing in medical practice. These terms not only facilitate better communication among healthcare providers but also enhance patient understanding of their condition. If you need further information on treatment options or management strategies for chronic venous hypertension, feel free to ask!

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity is classified under the ICD-10-CM code I87.313. This diagnosis is associated with a range of clinical criteria and considerations that healthcare providers must evaluate to ensure accurate coding and treatment. Below are the key criteria used for diagnosis:

Clinical Presentation

1. Symptoms: Patients typically present with symptoms such as:
   - Swelling in the legs, particularly after prolonged standing or sitting.
   - Pain or heaviness in the legs, which may improve with elevation.
   - Skin changes, including discoloration or thickening of the skin around the ankles.
   - Presence of ulcers, which are often located on the lower extremities, particularly around the medial malleolus (inner ankle).

2. Ulcer Characteristics: The ulcers associated with chronic venous hypertension are usually:
   - Shallow and irregular in shape.
   - Surrounded by edema and may have a reddish-brown discoloration of the skin (stasis dermatitis).
   - Often accompanied by exudate and may be painful.

Diagnostic Tests

1. Physical Examination: A thorough physical examination is essential, focusing on the lower extremities to assess for:
   - Varicosities (enlarged veins).
   - Signs of venous stasis, such as edema and skin changes.
   - The presence and characteristics of ulcers.

2. Doppler Ultrasound: Noninvasive venous studies, such as Doppler ultrasound, are critical for:
   - Evaluating venous reflux and obstruction.
   - Assessing the function of the venous valves.
   - Confirming the diagnosis of chronic venous insufficiency, which is often a precursor to chronic venous hypertension.

3. Ankle-Brachial Index (ABI): This test may be performed to rule out arterial disease, ensuring that the ulcers are indeed venous in origin rather than arterial.

Exclusion Criteria

1. Other Causes of Ulcers: It is crucial to exclude other potential causes of leg ulcers, such as:
   - Arterial insufficiency.
   - Diabetes mellitus (diabetic ulcers).
   - Infection or malignancy.

2. Chronic Venous Insufficiency: The diagnosis of chronic venous hypertension is often made in the context of chronic venous insufficiency, which must be documented and confirmed through clinical findings and diagnostic imaging.

Documentation Requirements

1. Comprehensive Medical History: A detailed medical history should be documented, including:
   - Duration and progression of symptoms.
   - Previous treatments and their outcomes.
   - Any comorbid conditions that may affect venous health.

2. Treatment Response: Documentation of the patient's response to conservative treatments, such as compression therapy, is also important for establishing the diagnosis and guiding further management.

In summary, the diagnosis of chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity (ICD-10 code I87.313) requires a combination of clinical evaluation, diagnostic testing, and exclusion of other conditions. Accurate documentation and thorough assessment are essential for effective management and coding.

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity, classified under ICD-10 code I87.313, is a condition characterized by increased pressure in the venous system of the legs, leading to skin changes and ulceration. The management of this condition typically involves a combination of conservative measures, medical treatments, and, in some cases, surgical interventions. Below is a detailed overview of standard treatment approaches for this condition.

Conservative Management

1. Compression Therapy

Compression therapy is a cornerstone of treatment for chronic venous hypertension. It involves the use of graduated compression stockings or bandages to improve venous return and reduce edema. The compression helps to alleviate symptoms and promote healing of ulcers by enhancing blood flow and reducing venous pressure[1].

2. Wound Care

Proper wound care is essential for managing ulcers associated with chronic venous hypertension. This includes:
- Debridement: Removal of necrotic tissue to promote healing.
- Moist wound healing: Use of appropriate dressings that maintain a moist environment, which is conducive to healing.
- Infection control: Monitoring for signs of infection and using topical or systemic antibiotics as needed[2].

3. Elevation of the Legs

Patients are often advised to elevate their legs above heart level to reduce venous pressure and swelling. This can be particularly beneficial during periods of rest or sleep[3].

Medical Treatments

1. Pharmacological Interventions

Medications may be prescribed to manage symptoms and promote healing. These can include:
- Venoactive drugs: Such as flavonoids, which may help improve venous tone and reduce symptoms of venous insufficiency.
- Topical agents: For ulcer management, including antiseptics and healing-promoting ointments[4].

2. Management of Comorbid Conditions

Addressing underlying conditions such as obesity, diabetes, or heart failure is crucial, as these can exacerbate venous hypertension and impede healing[5].

Surgical Interventions

1. Endovenous Laser Treatment (EVLT) or Radiofrequency Ablation (RFA)

For patients with significant venous reflux contributing to chronic venous hypertension, minimally invasive procedures like EVLT or RFA may be indicated. These techniques involve the closure of incompetent veins, thereby reducing venous pressure and improving symptoms[6].

2. Vein Stripping or Ligation

In more severe cases, traditional surgical options such as vein stripping or ligation may be considered. These procedures remove or tie off problematic veins to improve venous circulation[7].

3. Sclerotherapy

Sclerotherapy involves the injection of a sclerosing agent into the affected veins, causing them to collapse and reroute blood flow to healthier veins. This can be effective for smaller varicosities and may complement other treatments[8].

Follow-Up and Monitoring

Regular follow-up is essential to monitor the healing of ulcers and the effectiveness of the treatment plan. Adjustments may be necessary based on the patient's response to therapy and any complications that arise[9].

Conclusion

The management of chronic venous hypertension with ulceration in the bilateral lower extremities requires a multifaceted approach that includes conservative measures, medical treatments, and potential surgical interventions. Early and effective treatment is crucial to prevent complications and promote healing. Patients should work closely with their healthcare providers to develop a personalized treatment plan that addresses their specific needs and circumstances.

References

1. Article - Billing and Coding: Treatment of Chronic Venous ...
2. Treatment of varicose veins of the lower extremity - MCS
3. Noncompliance with Guidelines on the Use of Ultrasound ...
4. Medical Policy Skin Substitute Grafts/Cellular and/or Tissue ...
5. Wound and Burn Management and Specialized Treatment ...
6. Varicose Vein Treatment - Last Review Date
7. June 17, 2016 Andrew M. Slavitt Acting Administrator ...
8. Palmetto Medicare Policy Primer
9. Billing and Coding: Treatment of Chronic Venous ...