Q&A: Acute versus chronic PE/DVT

Q: One of my CDI staff members recently asked me for resources to help differentiate between an acute pulmonary embolism (PE)/deep vein thrombosis (DVT) and a chronic PE/DVT. She’s looking for anything that could help her explain the difference to a physician, but I’m having trouble finding any resources. Could you point me in the right direction? Is there a timeline that you know of?

A: This more of an example of physician judgement rather than a circumstance where CDI specialists should be teaching the difference to a physician. Coding Clinic does not specify a time limit or threshold to distinguish acute from chronic. The time limits are not specified within the ICD-10 code set either.

Instead, the differentiation should be based on the physician’s clinical judgement regarding the period of time when the acute management of diagnosing—dealing with initial pain control and establishing a treatment protocol is occurring (likely the acute phase)—versus the phase where only monitoring blood tests, ultrasounds, and medication management is performed (likely the chronic period).

I have asked this question myself and gotten a variety of answers, from the initial stay only being the acute phase, all the way up to and including the entire first three months of management being the acute phase. Likewise, I have gotten a range of answers regarding the appropriateness of reporting chronic DVT ranging from after the first 10 days up to the one-year point.

My personal feeling is that chronic DVT should be defined as any DVT between one month and six months and/or including any continuing evidence on an ultrasound or from swelling and edema up to one year. I believe one month is a good compromise for the acute period.

A brief parting warning, though: I can cite no literature for this nor can I source it. This opinion is simply an amalgamation and compromise I came up with by averaging several definitions together and then throwing in a dash of “being conservative.”

I think this ultimately come down to the need for developing definitions based on your providers’ independent rationale and logic, or even better, rationale from a physician champion.

Editor’s note: Allen Frady, RN, BSN, CCDS, CCS, CRC, CDI education specialist for HCPro in Middleton, Massachusetts, answered this question. Contact him at AFrady@hcpro.com. For information regarding CDI Boot Camps, click here.