Monitoring Surgical Patients for VTE May Result in Higher RAFs

January 3rd, 2022 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT
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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

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