Monitoring Surgical Patients for VTE May Result in Higher RAFs

January 3rd, 2022 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
Categories:   Billing  
0 Votes - Sign in to vote or comment.

A news release published in the American Association for the Advancement of Science (AAAS) included findings of a global surgery study identifying patients with either a current, recent, or previous COVID-19 infection have up to a five-times increased risk of death from venous thromboembolism (VTE) when undergoing a surgical procedure. 

Venous thromboembolism is a blood clot that develops in a vein and then becomes an embolism when the blood clot breaks loose, traveling through the vein until it reaches a vessel opening that is too small for it to pass through, blocking blood flow through that vessel. Embolisms and blood clots increase the risk of death considerably and often result in the need for long-term anticoagulation therapy, which presents additional risks. Signs and symptoms of an embolism or blood clot include difficulty breathing, shortness of breath, right-sided chest pain, or swelling of a lower leg. 

The study identifies the increased risk of developing  VTE associated with the timeframe in which the patient had COVID-19, as follows: 

COVID-19 Infection Risk of Venous Thromboembolism (blood clot)
Previous infection 70% increased risk
Recent infection 90% increased risk
Current infection 50% increased risk

*Note, the study did not provide a definition for previous infection versus recent infection. 

Remember that the study is referring to the risk associated with patients undergoing surgical procedures and not the general public as a whole. Patients who undergo surgery are already at an increased risk for blood clots due to immobility (either following surgery  or prior to it), pre-and postoperative inflammation (sometimes systemic in nature), and wounds (either from an injury or postsurgically). With the additional cardiovascular complications arising from COVID-19, there is an increased risk to the average surgical patient, thus qualifying them for HCC codes they otherwise would not have qualified for. 

Increased monitoring of patients preparing for surgery should include a careful review of their medical history specifically relating to if and when they had COVID-19 and documenting this carefully for surgical preparation and postsurgical monitoring. Of note, the study did not include information identifying patients who may have been treated prophylactically with anticoagulants prior to the decision for surgery or in the immediate preoperative period to prevent such blood clots. This information would have helped to shed additional light on potential risk and outcomes. 

The following ICD-10-CM code categories are risk adjustable for not only CMS, but HCC, ESRD, and RX HCCs: 

ICD-10-CM Code Description
I26.- Pulmonary embolism
I82.- Other venous embolism and thrombosis


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)
October 27th, 2022 - CMS - MLNConnects
Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...
2023 Evaluation & Management Updates Free Webinar
October 24th, 2022 - Aimee Wilcox
Congratulations on a successful 2021 implementation of the Evaluation and Management (E/M) changes! That was a big change, but now an even bigger change is headed your way for inpatient and all other E/M categories. How great is it that almost all of the E/M categories will now be scored based on medical decision making (MDM) or total provider time? Standardized scoring and one set of E/M guidelines has the potential of bringing about a change or improvement of provider fatigue due to over regulation and documentation burden.
Are Leading Queries Prohibited by Law or Lore?
October 13th, 2022 - Erica E. Remer
AHIMA released its CDI Practice Brief Monday. At Yom Kippur services, I found myself thinking about the question Dr. Ronald Hirsch posed to me the day before. My rabbi was talking in her sermon about the difference between halacha and minhag. Halacha is law; it is the prescriptions...
2023 ICD-10-CM Guideline Changes
October 13th, 2022 - Chris Woolstenhulme
View the ICD-10-CM Guideline Changes for 2023 Chapter 19 (Injury, poisoning, and certain other consequences of external causes [S00-T88])The guidelines clarify that coders do not need to see a change in the patient’s condition to assign an underdosing code. According to the updated guidelines, “Documentation that the patient is taking less ...
Z Codes: Understanding Palliative Care and Related Z Codes
October 11th, 2022 - Gloryanne Bryant
Palliative care is often considered to be hospice and comfort care. Palliative care is sometimes used interchangeably with “comfort care” and then again sometimes with “hospice care.”  But these terms do have slightly different meanings and sometimes the meaning varies depending on who is stating it. The National...
2023 ICD-10-CM Code Changes
October 6th, 2022 - Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
In 2022 there were 159 new codes; the 2023 ICD-10-CM code update includes 1,176 new, 28 revised, and 287 deleted codes, a substantial change from last year. The 2023 ICD-10-CM codes are to be used for discharges from October 1, 2022 through September 30, 2023, and for patient encounters from ...
Yes, You Have What It Takes To Lead Your Practice And Your Profession
September 20th, 2022 - Kem Tolliver
If you’ve been in any healthcare role for more than two years, you’ve seen quite a bit of change. And guess what, it’s not over. We are living and working in uncertain times. This climate requires each of us to step outside of our comfort zones to lead exactly where we stand. It’s not required of one to have a “title” to lead. What is required, however, is a willingness to trust your instincts, look for answers and rely on your team.

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association