Health Care Providers (HCPs)

DEEP VEIN THROMBOSIS

References for Common Prior Authorization Questions

Diagnosis Code

Guideline Recommendation for DOAC as first line therapy:

Use of a direct oral anticoagulant (apixaban, dabigatran, edoxaban, or rivaroxaban) is considered first line therapy for treatment of acute deep vein thrombosis and is recommended preferentially over warfarin therapy. (American College of Chest Physicians Guideline, 2016).

Reference: Chest 2016;149:315-52

Renal Function and DOACs:

Renal function (serum creatinine and/or creatinine clearance) will be followed regularly to ensure appropriate dosing.

Online calculator for Creatinine Clearance (using age, gender, weight and serum creatinine): //nephron.com/cgi-bin/CGSI.cgi

ICD-9-CM:

453.41

(Acute venous embolism and thrombosis of deep veins of proximal lower extremity) – use for DVT of iliac, femoral and popliteal veins

453.42

(Acute venous embolism and thrombosis of deep veins of distal lower extremity) – use for DVT of anterior and posterior tibial veins and peroneal veins

453.42

(Acute venous embolism and thrombosis of unspecified deep veins)

ICD-10-CM:

I82.419

(Acute embolism and thrombosis of unspecified femoral vein)

I82.428

(Acute embolism and thrombosis of unspecified iliac vein)

I82.439

(Acute embolism and thrombosis of unspecified popliteal vein)

I82.4Y9

(Acute embolism and thrombosis of unspecified deep veins of unspecified proximal lower extremity)

I82.449

(Acute embolism and thrombosis of unspecified tibial vein)

I82.499

(Acute embolism and thrombosis of other specified deep vein of unspecified lower extremity)

I82.4Z9

(Acute embolism and thrombosis of unspecified deep veins of unspecified distal lower extremity)