2025 ICD-10-CM code Z86.718
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Chapter 21: Factors influencing health status and contact with health services Feed
Personal history of other venous thrombosis and embolism.
No modifiers are applicable to Z86.718.
The medical necessity for coding Z86.718 rests on the accurate documentation of a past VTE event. This information is essential for risk assessment, preventative strategies, and ongoing patient care.If current symptoms exist, a code reflecting the active condition would take precedence.
The clinical responsibility for this code involves documenting a complete history of the patient's previous VTE, including details such as location, date of occurrence, treatment received, and current status. The physician should ensure that documentation supports the absence of any current symptoms or ongoing treatment for the condition. If the patient is on anticoagulation, a separate code may be necessary to reflect this.
- Chapter 21: Factors influencing health status and contact with health services
- Z86.718 falls under the broader category Z86.71, which itself is under Z86.7 (Personal history of certain other diseases) and ultimately under Chapter 21 (Factors influencing health status and contact with health services).
In simple words: The patient has had a blood clot in a vein in the past, but it is not causing problems now and they are not getting treatment for it.
This code signifies a documented history of venous thromboembolism (VTE) other than pulmonary embolism or specified venous thrombosis.It indicates a past occurrence of a blood clot in a vein, excluding those specifically addressed by other codes within the Z86.71 category.This code is used when the patient is currently asymptomatic and not receiving active treatment for the condition.
Example 1: A 60-year-old female presents for a routine check-up.Her medical history reveals a deep vein thrombosis (DVT) in her left leg 18 months ago, which was successfully treated with anticoagulation.She is currently asymptomatic and off anticoagulation.Z86.718 is appropriate here., A 45-year-old male is admitted for an unrelated procedure.His history includes a pulmonary embolism 5 years prior, treated successfully.Currently asymptomatic.While Z86.711 (personal history of pulmonary embolism) is more specific, Z86.718 could also be used depending on physician preference and documentation., A 30-year-old female presents for follow-up after a previous DVT.She completed a course of anticoagulation and is now asymptomatic.She is being seen for general health and risk factor management. Z86.718 would be appropriate, and additional codes could be added to reflect her current health status and risk factors.
Documentation should clearly indicate a past history of venous thromboembolism (VTE). This should include the date(s) of the event(s), location of the clot, and details on the treatment rendered.The current asymptomatic status and absence of active treatment should be explicitly documented to support the use of Z86.718.
** When coding a past VTE, always ensure that the documentation clearly differentiates between a past event and a current, active condition.Accurate documentation is crucial to avoid coding errors and ensure appropriate reimbursement.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Hematology, Cardiology, Vascular Surgery, Internal Medicine, Family Medicine
- Place of Service:Office, Outpatient Hospital, Inpatient Hospital