ICD-10: O22.33
Deep phlebothrombosis in pregnancy, third trimester
Additional Information
Diagnostic Criteria
The ICD-10 code O22.33 refers specifically to "Deep phlebothrombosis in pregnancy, third trimester." This diagnosis is part of a broader classification of conditions related to venous thromboembolism during pregnancy. Understanding the criteria for diagnosing this condition is crucial for accurate coding and effective patient management.
Diagnostic Criteria for O22.33
Clinical Presentation
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Symptoms: Patients may present with symptoms such as unilateral leg swelling, pain, tenderness, and warmth in the affected limb. These symptoms are indicative of deep vein thrombosis (DVT) and should be carefully evaluated in the context of pregnancy.
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Risk Factors: The presence of risk factors for thromboembolism is significant. These may include:
- Previous history of DVT or pulmonary embolism.
- Prolonged immobility (e.g., long flights, bed rest).
- Obesity.
- Advanced maternal age.
- Certain medical conditions (e.g., thrombophilia).
Diagnostic Imaging
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Ultrasound: The primary diagnostic tool for confirming DVT in pregnant patients is a Doppler ultrasound. This non-invasive imaging technique assesses blood flow in the veins and can identify clots in the deep venous system.
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Other Imaging Techniques: In some cases, if ultrasound results are inconclusive, further imaging such as magnetic resonance imaging (MRI) may be considered, although it is less common due to safety concerns in pregnancy.
Laboratory Tests
- D-dimer Levels: While D-dimer testing can be useful in the general population for ruling out DVT, its interpretation in pregnant women is complex due to naturally elevated levels during pregnancy. Therefore, D-dimer results should be considered alongside clinical findings and imaging results.
Clinical Guidelines
- Guidelines and Protocols: Adherence to established clinical guidelines, such as those from the American College of Obstetricians and Gynecologists (ACOG), is essential. These guidelines provide recommendations on the management and diagnosis of thromboembolic events in pregnant patients.
Exclusion of Other Conditions
- Differential Diagnosis: It is important to rule out other conditions that may mimic DVT symptoms, such as cellulitis, muscle strain, or Baker's cyst. A thorough clinical evaluation is necessary to ensure an accurate diagnosis.
Conclusion
The diagnosis of deep phlebothrombosis in pregnancy, particularly in the third trimester, requires a comprehensive approach that includes clinical assessment, imaging studies, and consideration of risk factors. Accurate coding with ICD-10 code O22.33 is essential for proper documentation and management of the condition, ensuring that pregnant patients receive appropriate care and monitoring for potential complications associated with venous thromboembolism.
Description
Deep phlebothrombosis (DVT) during pregnancy is a significant clinical concern, particularly in the third trimester, when the risk factors for venous thromboembolism (VTE) are heightened. The ICD-10 code O22.33 specifically designates "Deep phlebothrombosis in pregnancy, third trimester," which is crucial for accurate diagnosis, treatment, and billing purposes.
Clinical Description
Definition of Deep Phlebothrombosis
Deep phlebothrombosis refers to the formation of a blood clot (thrombus) in a deep vein, most commonly in the legs. This condition can lead to serious complications, including pulmonary embolism, where a clot dislodges and travels to the lungs, potentially causing life-threatening consequences.
Risk Factors in Pregnancy
Pregnancy itself is a well-known risk factor for DVT due to several physiological changes, including:
- Increased Blood Coagulation: Hormonal changes during pregnancy increase the levels of clotting factors, which can predispose women to thrombus formation.
- Venous Stasis: As the uterus enlarges, it can compress pelvic veins, leading to reduced blood flow and increased stasis.
- Reduced Mobility: Pregnant women may experience decreased mobility, especially in the later stages of pregnancy, which can further contribute to venous stasis.
Symptoms
Symptoms of DVT can vary but often include:
- Swelling in one leg (more common than the other)
- Pain or tenderness in the affected leg, often described as a cramp or soreness
- Warmth and redness over the affected area
Diagnosis
Diagnosis typically involves a combination of clinical evaluation and imaging studies. Common diagnostic tools include:
- Ultrasound: The primary method for diagnosing DVT, particularly in the legs.
- D-dimer Test: A blood test that can indicate the presence of an abnormal blood clot, although it is not specific.
Coding and Billing Implications
ICD-10 Code O22.33
The ICD-10 code O22.33 is used specifically for billing and coding purposes to identify cases of DVT occurring during the third trimester of pregnancy. Accurate coding is essential for:
- Insurance Reimbursement: Ensuring that healthcare providers are reimbursed for the care provided.
- Epidemiological Tracking: Assisting in the collection of data related to pregnancy complications and outcomes.
Related Codes
Other related codes in the O22 category include:
- O22.30: Deep phlebothrombosis in pregnancy, unspecified trimester.
- O22.31: Deep phlebothrombosis in pregnancy, first trimester.
- O22.32: Deep phlebothrombosis in pregnancy, second trimester.
Management and Treatment
Management of DVT in pregnant women typically involves:
- Anticoagulation Therapy: The use of anticoagulants, such as low molecular weight heparin (LMWH), is common to prevent clot extension and reduce the risk of pulmonary embolism.
- Compression Stockings: Graduated compression stockings may be recommended to improve venous return and reduce swelling.
- Monitoring: Close monitoring of the mother and fetus is essential to ensure safety and manage any complications.
Conclusion
Deep phlebothrombosis in pregnancy, particularly during the third trimester, is a critical condition that requires prompt diagnosis and management. The ICD-10 code O22.33 serves as an important tool for healthcare providers in accurately documenting and billing for this condition. Understanding the clinical implications, risk factors, and treatment options is vital for ensuring the health and safety of both the mother and the developing fetus.
Clinical Information
The ICD-10 code O22.33 refers to "Deep phlebothrombosis in pregnancy, third trimester." This condition is a significant concern during pregnancy, particularly in the later stages, due to the increased risk of venous thromboembolism (VTE). Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.
Clinical Presentation
Deep vein thrombosis (DVT) in pregnancy, especially during the third trimester, is characterized by the formation of a blood clot in the deep veins, typically in the legs. The clinical presentation can vary, but it often includes a combination of the following:
Signs and Symptoms
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Swelling: One of the most common signs of DVT is unilateral swelling of the affected leg. This swelling may be accompanied by a feeling of heaviness in the leg[1].
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Pain and Tenderness: Patients may experience pain or tenderness in the calf or thigh, which can be exacerbated by movement or palpation of the affected area. The pain may be described as a cramp or ache[1][2].
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Skin Changes: The skin over the affected area may appear red or discolored, and it may feel warm to the touch. These changes are due to inflammation and increased blood flow to the area[2].
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Homan's Sign: Although not a definitive diagnostic tool, Homan's sign (pain in the calf upon dorsiflexion of the foot) may be present in some cases[1].
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Asymptomatic Cases: It is important to note that some patients may be asymptomatic, making routine screening essential, especially in high-risk populations[2].
Patient Characteristics
Certain patient characteristics can increase the risk of developing DVT during pregnancy, particularly in the third trimester:
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Obesity: Overweight or obese individuals are at a higher risk for thromboembolic events due to increased venous pressure and reduced mobility[3].
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Age: Women over the age of 35 are more susceptible to DVT during pregnancy[3].
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Previous History of Thrombosis: A personal or family history of venous thromboembolism significantly increases the risk of DVT in pregnant women[3][4].
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Prolonged Immobility: Extended periods of immobility, such as long flights or bed rest, can contribute to the development of DVT[4].
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Multiple Pregnancies: Women carrying multiples (twins, triplets, etc.) are at a higher risk due to increased uterine size and pressure on pelvic veins[3].
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Certain Medical Conditions: Conditions such as antiphospholipid syndrome, sickle cell disease, or other hypercoagulable states can predispose women to DVT during pregnancy[4].
Conclusion
Deep phlebothrombosis in pregnancy, particularly during the third trimester, presents with a range of signs and symptoms, including swelling, pain, and skin changes in the affected leg. Understanding the patient characteristics that contribute to the risk of DVT is crucial for early identification and management. Given the potential complications associated with DVT, including pulmonary embolism, it is essential for healthcare providers to monitor at-risk patients closely and implement preventive measures as necessary. Regular screening and patient education on recognizing symptoms can significantly improve outcomes for pregnant women.
References
- Risk Factors for Venous Thromboembolism in 1.3 Million Pregnancies.
- The Incidence of First Venous Thromboembolism in Pregnancy.
- Pregnancy-related thromboembolism in women with sickle cell disease.
- D-Dimer levels at different stages of pregnancy in relation to thromboembolic events.
Approximate Synonyms
ICD-10 code O22.33 specifically refers to "Deep phlebothrombosis in pregnancy, third trimester." This condition is characterized by the formation of a blood clot in a deep vein, typically in the legs, during the later stages of pregnancy. Understanding alternative names and related terms can help in better communication and documentation in medical settings.
Alternative Names for O22.33
- Deep Vein Thrombosis (DVT) in Pregnancy: This is a more general term that encompasses the condition without specifying the trimester.
- Pregnancy-Related DVT: This term highlights the association of the condition with pregnancy.
- Third Trimester DVT: This specifies the timing of the condition, indicating that it occurs during the last three months of pregnancy.
Related Terms
- Venous Thromboembolism (VTE): This broader term includes both deep vein thrombosis and pulmonary embolism, which can occur if a clot dislodges and travels to the lungs.
- Thrombosis: A general term for the formation of a blood clot within a blood vessel.
- Phlebothrombosis: This term specifically refers to thrombosis in the veins, which is relevant to the condition described by O22.33.
- Pregnancy Complications: DVT is considered a complication that can arise during pregnancy, particularly in the later stages.
- Obstetric Thrombosis: This term refers to thrombotic events occurring in pregnant women, encompassing various types of thrombosis, including DVT.
Clinical Context
Deep vein thrombosis during pregnancy, particularly in the third trimester, is a significant concern due to the increased risk factors associated with pregnancy, such as hormonal changes, increased blood volume, and reduced blood flow in the pelvic region. Awareness of these alternative names and related terms is crucial for healthcare providers in diagnosing, coding, and managing the condition effectively.
In summary, understanding the terminology surrounding ICD-10 code O22.33 can enhance clarity in medical documentation and communication, ensuring that healthcare professionals are aligned in their approach to managing deep phlebothrombosis in pregnant patients.
Treatment Guidelines
The ICD-10 code O22.33 refers to "Deep phlebothrombosis in pregnancy, third trimester," which indicates the presence of deep vein thrombosis (DVT) occurring during the later stages of pregnancy. This condition poses significant risks to both the mother and the fetus, necessitating careful management and treatment. Below is a detailed overview of standard treatment approaches for this condition.
Understanding Deep Phlebothrombosis in Pregnancy
Deep vein thrombosis is a condition where a blood clot forms in a deep vein, commonly in the legs. During pregnancy, the risk of DVT increases due to several factors, including hormonal changes, increased blood volume, and pressure from the growing uterus on pelvic veins. The third trimester is particularly critical as the risk of thromboembolic events escalates.
Standard Treatment Approaches
1. Anticoagulation Therapy
Anticoagulation is the primary treatment for DVT in pregnant women. The following medications are commonly used:
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Low Molecular Weight Heparin (LMWH): Medications such as enoxaparin (Lovenox) are preferred due to their safety profile during pregnancy. LMWH is administered via subcutaneous injection and is effective in preventing clot progression and recurrence[1].
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Unfractionated Heparin: In certain cases, unfractionated heparin may be used, especially in patients with renal impairment or those requiring rapid reversal of anticoagulation[2].
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Warfarin: Generally avoided during pregnancy due to teratogenic effects, warfarin may be considered postpartum or in specific cases where the benefits outweigh the risks[3].
2. Compression Therapy
Graduated compression stockings are often recommended to improve venous return and reduce swelling. These stockings can help alleviate symptoms and may prevent the development of DVT in high-risk patients[4].
3. Monitoring and Follow-Up
Regular monitoring is crucial for pregnant women diagnosed with DVT. This includes:
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Ultrasound Imaging: Follow-up ultrasounds may be performed to assess the status of the clot and ensure it is not extending or causing complications[5].
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Clinical Assessment: Regular evaluations of symptoms, such as leg swelling, pain, or changes in skin color, are essential to monitor for potential complications like pulmonary embolism[6].
4. Lifestyle Modifications
Encouraging lifestyle changes can also play a role in managing DVT risk:
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Hydration: Maintaining adequate hydration helps to reduce blood viscosity.
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Physical Activity: Encouraging safe physical activity, such as walking, can improve circulation and reduce the risk of clot formation[7].
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Positioning: Pregnant women should be advised to avoid prolonged periods of immobility and to elevate their legs when resting[8].
5. Delivery Considerations
In cases of severe DVT, the timing and method of delivery may need to be adjusted. An interdisciplinary approach involving obstetricians, hematologists, and anesthesiologists is essential to ensure the safety of both mother and baby during labor and delivery[9].
Conclusion
The management of deep phlebothrombosis in pregnancy, particularly in the third trimester, requires a comprehensive approach that includes anticoagulation therapy, compression therapy, and lifestyle modifications. Regular monitoring and a collaborative care strategy are vital to mitigate risks and ensure favorable outcomes for both the mother and the fetus. Pregnant women should be educated about the signs and symptoms of DVT and the importance of seeking immediate medical attention if they suspect a clot.
References
- National Coding Advice.
- Genetic Testing - Medical Clinical Policy Bulletins.
- ICD-10-CM C&M September 2016 Diagnosis Agenda.
- The Incidence of First Venous Thromboembolism in and.
- AESI Case Definition Companion Guide Thrombosis and.
- Pregnancy‐related thromboembolism in women with sickle.
- Billing and Coding: Non-Invasive Peripheral Venous Studies.
- Billing and Coding: Non-Invasive Peripheral Venous Studies.
- National Coding Advice.
Related Information
Diagnostic Criteria
- Symptoms: unilateral leg swelling and pain
- Previous history of DVT or PE
- Prolonged immobility during pregnancy
- Ultrasound used as primary diagnostic tool
- D-dimer levels interpreted with caution
- Adhere to ACOG guidelines for management
- Rule out other conditions mimicking DVT symptoms
Description
- Blood clot forms in deep vein
- Most common in legs during pregnancy
- Pulmonary embolism can be life-threatening
- Increased blood coagulation during pregnancy
- Venous stasis due to pelvic vein compression
- Reduced mobility increases risk of DVT
- Symptoms include swelling, pain and tenderness
- Diagnosis involves ultrasound and d-dimer test
Clinical Information
- Swelling of the affected leg
- Pain or tenderness in the calf or thigh
- Skin changes with redness and warmth
- Homan's sign may be present
- Asymptomatic cases can occur
- Obesity increases risk of DVT
- Age over 35 increases risk
- Previous history of thrombosis increases risk
- Prolonged immobility increases risk
- Multiple pregnancies increase risk
Approximate Synonyms
- Deep Vein Thrombosis (DVT)
- Pregnancy-Related DVT
- Third Trimester DVT
- Venous Thromboembolism (VTE)
- Thrombosis
- Phlebothrombosis
- Pregnancy Complications
- Obstetric Thrombosis
Treatment Guidelines
- Anticoagulation with LMWH preferred
- Unfractionated Heparin used in renal impairment
- Warfarin avoided during pregnancy
- Compression therapy with graduated stockings
- Regular ultrasound imaging for clot monitoring
- Hydration to reduce blood viscosity
- Encourage physical activity and leg elevation
Related Diseases
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