I82.549 ICD-10-CM Code: Chronic embolism and thrombosis of unspecified tibial vein

Code

I82.549

Description

Chronic embolism and thrombosis of unspecified tibial vein

HCC (V28)

HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism

RAF reference coefficient

0.294

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I82.549 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I82.549

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I82.549 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use this code only when the side of the tibial vein thrombosis is not documented; query provider if laterality can be determined.
• •Tibial veins are important deep veins in the lower extremity, so documentation of laterality is clinically important.

Clinical Significance

Chronic tibial vein thrombosis represents a persistent deep vein thrombosis in the distal lower extremity venous system. Although distal deep vein thrombosis has traditionally been considered lower risk than proximal deep vein thrombosis, chronic tibial vein thrombosis can cause significant post-thrombotic symptoms and may propagate proximally. This diagnosis is relevant for risk adjustment as it demonstrates ongoing vascular disease requiring continued monitoring and treatment.

Documentation Requirements

• ✓Provider documentation explicitly stating 'chronic' deep vein thrombosis (not assumed from duration of treatment)
• ✓Clinical evidence supporting the diagnosis such as duplex ultrasound, venography, or other imaging results
• ✓Specific vein location documented (e.g., tibial)
• ✓Query provider for laterality (right, left, or bilateral) when not documented
• ✓Current treatment plan including anticoagulation therapy and duration
• ✓Assessment and monitoring notes demonstrating the condition is being actively managed
• ✓Documentation of chronicity such as 'chronic,' 'old,' 'long-standing,' or history of prior acute deep vein thrombosis that has transitioned to chronic status

Commonly Confused Codes

• •I82.449: Acute embolism and thrombosis of tibial vein; confirm documentation explicitly states chronic
• •I82.55-: Chronic embolism and thrombosis of peroneal vein; the peroneal vein runs parallel to the tibial but is a separate vessel
• •I82.53-: Chronic embolism and thrombosis of popliteal vein; the popliteal is more proximal than the tibial vein
• •I82.5Z-: Chronic embolism of unspecified deep veins of distal lower extremity; use the tibial-specific code when documentation specifies the tibial vein

Child Codes