🧬 ICD-10 CM I82.441 — Acute Embolism and Thrombosis of Right Tibial Vein
Billable Code Confirmed
ICD-10 CM I82.441 is a fully specified 6-character code combining category (I82.4, deep vein embolism/thrombosis of lower extremity), subcategory (I82.44, tibial vein), and 6th-character digit 1 (right side, acute), leaving no further subdivision required. It is valid for HIPAA-covered transactions for the full **FY2026 cycle (October 1, 2025 through September 30, 2026)**³.
Non-Billable Parent Codes
I82.44 (Acute embolism and thrombosis of tibial vein) is a non-billable header — it lacks the required 7th character for laterality and must never be reported alone⁴. I82.4 (Acute embolism and thrombosis of deep veins of lower extremity) is a non-billable category-level code — it does not specify which deep vein is involved. I82 (Other venous embolism and thrombosis) is a non-billable chapter-level parent — far too broad for any claim.
Clinical Context
Selection of I82.441 over a sibling code hinges on precise vein-level documentation — imaging (duplex ultrasound) must specifically identify the posterior or anterior tibial vein, rather than a more proximal vein (popliteal, femoral, iliac) or an unspecified/non-visualized vein, to support this exact code.
Code Classification
This is a diagnosis code (ICD-10-CM), used to report the presence of an acute thrombotic/embolic event in a named deep calf vein; it carries no procedural or reimbursement value on its own and must be paired with appropriate evaluation/management or procedural CPT codes to generate a claim.
🔍 Code Description
ICD-10 CM I82.441 describes an acute thrombus or embolus lodged within the right tibial vein, one of the paired deep veins of the calf that drains into the popliteal vein. Unlike I82.431 (popliteal vein) or I82.411 (femoral vein), which describe more proximal deep venous thrombi carrying a comparatively higher embolic risk, isolated tibial (distal/calf) DVT is generally considered lower-risk for pulmonary embolism, though it still warrants anticoagulation in most symptomatic or risk-factor-positive patients.
Clinically, this code applies to a new (acute, generally within roughly four weeks of onset) thrombotic event confirmed by duplex ultrasound or other venous imaging, presenting with calf swelling, tenderness, warmth, or a positive Homans’ sign. It is distinguished from I82.541 (chronic embolism and thrombosis of right tibial vein), which is reserved for a residual, longstanding, or post-thrombotic clot rather than a newly formed one — this acute/chronic distinction is one of the most frequent CDI query triggers in venous thromboembolism documentation.
🌳 Code Tree / Hierarchy
I82 Other venous embolism and thrombosis ❌ Non-billable
│
├── I82.4 Acute embolism and thrombosis of deep veins of lower extremity ❌ Non-billable
│ │
│ ├── I82.41 Acute embolism and thrombosis of femoral vein ❌ Non-billable
│ │ ├── I82.411 …… right leg ✅ Billable
│ │ └── I82.412 …… left leg ✅ Billable
│ │
│ ├── I82.43 Acute embolism and thrombosis of popliteal vein ❌ Non-billable
│ │ ├── I82.431 …… right leg ✅ Billable
│ │ └── I82.432 …… left leg ✅ Billable
│ │
│ ├── I82.44 Acute embolism and thrombosis of tibial vein ❌ Non-billable
│ │ │
│ │ ├── I82.442 …… left tibial vein ✅ Billable
│ │ ├── I82.443 …… tibial vein, bilateral ✅ Billable
│ │ └── I82.441 …… right tibial vein ◀ THIS CODE ✅ Billable
│ │
│ └── I82.45 Acute embolism and thrombosis of peroneal vein ❌ Non-billable
│
└── I82.5 Chronic embolism and thrombosis of deep veins of lower extremity ❌ Non-billableSpecificity Drives Reimbursement and Clinical Risk Stratification
Coding to the tibial-vein level (rather than defaulting to unspecified I82.40x) matters because payers and quality programs use vein-level location to assess PE risk and treatment duration; imprecise coding can also trigger a CDI query that delays claim submission.
Tip
Always confirm laterality and acuity together — a chart stating simply “DVT” without a time frame or side should trigger a provider query rather than a default assumption of “unspecified” or “right.”
✅ Includes
- Embolism of the right tibial vein, not otherwise specified.
- Thrombosis (vein) of the right tibial vein, not otherwise specified — inclusive of both the anterior and posterior tibial vein when a more specific named vessel is not separately documented.
- Acute deep venous thrombosis (DVT) of the right tibial (calf) vein, confirmed by imaging such as duplex ultrasound.
❌ Excludes
Excludes 1
- I82.4Y- — Acute embolism and thrombosis of unspecified deep veins of proximal lower extremity: this Excludes1 note attaches to the unspecified-vein subcategory (I82.40), not to I82.441 itself, since I82.441 already identifies a specific named vein.
- I82.4Z- — Acute embolism and thrombosis of unspecified deep veins of distal lower extremity: same rationale — mutually exclusive only with the unspecified-vein codes, not with a fully specified vein-level code like I82.441.
Danger
Excludes 2
- I26.9 (or other applicable I26.- code) — Pulmonary embolism: PE frequently coexists with lower-extremity DVT and should be coded separately in addition to I82.441 whenever documented, since one does not include the other.
- I63.6 / I67.6 — Cerebral venous embolism and thrombosis: an entirely separate vascular bed; code both if a patient has coexisting cerebral and lower-extremity venous thrombosis.
- K55.0- — Mesenteric venous embolism and thrombosis: also a separate vascular bed requiring its own code if simultaneously present.
📋 Clinical Overview
Acute vs. Chronic and Vein-Level Specificity
Accurate coding of lower-extremity DVT depends on two independent axes — acuity (acute vs. chronic) and anatomic level (femoral/popliteal/tibial/peroneal/calf muscular) — both of which must be separately confirmed in the documentation rather than assumed from a general “DVT” note.
| Feature | I82.441 | Related I82.431 | Related I82.541 |
|---|---|---|---|
| Vein level | Right tibial (distal/calf) vein — lower embolic risk tier. | Right popliteal vein — proximal DVT with materially higher PE risk. | Right tibial vein — same anatomic level as I82.441. |
| Acuity | Acute — new thrombus, typically within about 4 weeks of onset. | Acute — new thrombus. | Chronic — residual, longstanding, or post-thrombotic clot. |
| Typical management | Anticoagulation often for a shorter duration in isolated distal DVT without extension risk factors. | Anticoagulation is essentially always indicated given proximal PE risk. | Ongoing anticoagulation management and/or post-thrombotic syndrome care, not acute-phase treatment. |
Important
A documentation note reading only “DVT, right leg, on anticoagulation” without specifying acute vs. chronic and without the specific vein is a strong CDI query trigger — both axes materially change code assignment, HCC capture, and clinical management.
Manifestations & Symptom Burden
- Unilateral calf swelling, warmth, and tenderness are the classic presenting findings.
- Erythema or dusky discoloration of the affected calf may be present.
- A positive Homans’ sign (calf pain on dorsiflexion) is a classic but non-specific finding.
- Low-grade fever may accompany more extensive thrombosis.
- Asymptomatic presentation is possible, especially when detected incidentally on imaging obtained for another indication.
Tip
Code manifestations (e.g., limb swelling, pain) only when they represent a distinct reportable condition not inherent to the DVT diagnosis itself; routine expected symptoms of DVT do not require separate symptom codes.
💰 HCC Risk Adjustment
| Model | HCC Category | Base RAF Weight (Community, Non-Dual, Aged) |
|---|---|---|
| CMS-HCC V28 (fully phased in for PY2026) | HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism | ≈0.294¹ — flag to verify against the current CMS-HCC V28 model software before final risk-adjustment submission |
| CMS-HCC V24 (retired) | HCC 108 — Vascular Disease | ≈0.288¹ |
Because I82.441 maps to a payment HCC under V28, documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess/Address, Treat) at each face-to-face encounter for the condition to be captured for that payment year; a historical DVT that is no longer being actively managed should instead be considered for a personal-history code such as Z86.718 rather than re-reporting the acute code.
🏥 MS-DRG Assignment
| DRG | Title | Relative Weight (v43.0) |
|---|---|---|
| 299 | Peripheral Vascular Disorders with MCC | 1.6327² |
| 300 | Peripheral Vascular Disorders with CC | 1.0675² |
| 301 | Peripheral Vascular Disorders without CC/MCC | 0.7197² |
When I82.441 is the principal diagnosis, MDC 05 (Circulatory System) assigns it to DRG 299/300/301 depending on whether a qualifying MCC or CC is also captured on the same stay; failing to code a coexisting MCC/CC (e.g., acute PE, long-term anticoagulant use Z79.01, acute kidney injury) will default the case to the lowest-weighted DRG 301 even when a higher level of complexity was actually present. NCD/LCD note: there is no NCD or LCD written specifically against the ICD-10-CM diagnosis code I82.441 itself, since coverage determinations attach to procedures/services rather than diagnosis codes⁵. However, I82.441 commonly serves as the supporting diagnosis for several Medicare coverage policies, including NCD 190.11 (Home Prothrombin Time/INR Monitoring for Anticoagulation Management)⁶, and various MAC LCDs governing IVC filter placement, catheter-directed thrombolysis, and outpatient anticoagulation management — verify the specific service-level LCD/NCD against your MAC when billing the associated procedure.
🔗 Related ICD-10-CM Codes
Same Vein Family / Acuity Variants
- I82.442 — Acute embolism and thrombosis of left tibial vein
- I82.443 — Acute embolism and thrombosis of tibial vein, bilateral
- I82.541 — Chronic embolism and thrombosis of right tibial vein
- I82.431 — Acute embolism and thrombosis of right popliteal vein
- I82.411 — Acute embolism and thrombosis of right femoral vein
Etiology / Risk Factor Codes
- Z79.01 — Long term (current) use of anticoagulants
- D68.51 — Activated protein C resistance (a common inherited thrombophilia)
- Z86.718 — Personal history of other venous thrombosis and embolism
- I26.99 — Other pulmonary embolism without acute cor pulmonale
🛠️ Commonly Associated CPT Codes
- 93970 — Duplex scan of extremity veins, complete bilateral study; the primary diagnostic imaging code used to confirm and localize the thrombus.
- 93971 — Duplex scan of extremity veins, unilateral or limited study; used when only the symptomatic (right) leg is scanned.
- 37191 — Insertion of intravascular vena cava filter, endovascular approach; reported when a filter is placed due to anticoagulation contraindication.
- 37187 — Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections; used for mechanical clot removal in select cases.
- 85379 — D-dimer; quantitative assay, commonly ordered as part of the diagnostic workup preceding confirmatory imaging.
- 99232 — Subsequent hospital care, per day; frequently reported alongside I82.441 during an inpatient stay for anticoagulation initiation and monitoring.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -RT | Right Side | Appended to a bilateral-eligible CPT code (e.g., duplex scan) to specify the right leg was the side studied, consistent with the right-sided laterality of I82.441. |
| -LT | Left Side | Not applicable to a right-sided diagnosis alone, but included for reference when the same encounter also addresses the contralateral leg. |
| -59 | Distinct Service | Apply when a duplex scan or procedural service is performed as a separately identifiable service from another same-day procedure. |
| -25 | Significant E/M | Apply to a same-day E/M service that is significant and separately identifiable from a minor procedure performed for the DVT (e.g., duplex scan). |
NCCI Bundling Considerations
Duplex venous ultrasound codes (93970/93971) are generally not bundled with unrelated E/M services on the same date when a significant, separately identifiable evaluation is documented and modifier -25 is appended; verify current-quarter NCCI Procedure-to-Procedure edits before billing imaging alongside any interventional thrombectomy or filter-placement code on the same date of service.
🔬 ICD-10-PCS Crosswalk
- 06BQ3ZZ — Excision, tibial vein, right, percutaneous approach: relevant if a diagnostic or therapeutic tibial vein excision/biopsy procedure is performed during the same inpatient stay as the I82.441 diagnosis.
- 06BQ4ZZ — Excision, tibial vein, right, percutaneous endoscopic approach: alternative approach value for a minimally invasive excisional procedure on the same vein.
- 6A650ZZ — (Reference only, not directly linked to I82.441) — flag and verify against your encoder if systemic thrombolytic infusion therapy is separately reported for this condition.
- Most inpatient stays with I82.441 as principal diagnosis do not require any ICD-10-PCS code at all if managed purely with anticoagulation (a medication, not a procedure); PCS codes only become relevant when an actual procedure (thrombectomy, filter placement, thrombolysis catheter placement) is performed.
💊 Coding Scenarios and Examples
Example 1
Clinical Scenario: A 58-year-old male is admitted with new-onset right calf swelling and pain three days after a long-haul flight. Duplex ultrasound confirms an acute thrombus isolated to the right posterior tibial vein. He is started on therapeutic anticoagulation and discharged after 2 days with no complications and no CC/MCC captured.
| Field | Code | Rationale |
|---|---|---|
| CPT | 93971 | Unilateral limited duplex scan of the right leg confirms the diagnosis. |
| PDx | I82.441 | Acute, right-sided, tibial-vein-level DVT matches the imaging and clinical findings exactly. |
Tip
Sequencing: I82.441 is appropriately the principal diagnosis since it is the condition chiefly responsible for admission. With no CC/MCC captured, this case groups to DRG 301 — a CDI opportunity would be to query whether the long-term anticoagulation plan should be coded with Z79.01 if continued past discharge.
Example 2
Clinical Scenario: A 71-year-old female with active malignancy develops acute right tibial DVT and is found to have a contraindication to anticoagulation due to recent GI bleeding. An IVC filter is placed, and she is also found to have a concurrent acute kidney injury during the same admission.
| Field | Code | Rationale |
|---|---|---|
| CPT | 37191 | Endovascular IVC filter placement performed due to anticoagulation contraindication. |
| CPT 2 | 93970 | Complete bilateral duplex scan performed to assess for contralateral involvement given active malignancy risk. |
| PDx | I82.441 | Acute right tibial DVT remains the principal diagnosis driving the admission and filter placement. |
Tip
Sequencing: capturing the concurrent acute kidney injury as a secondary diagnosis (with its own specific ICD-10-CM code) would elevate this case from DRG 301 to DRG 299/300 depending on MCC/CC criteria — a significant CDI and reimbursement opportunity that should not be overlooked.
Example 3
Clinical Scenario: A 45-year-old male with a known factor V Leiden mutation presents for a routine outpatient follow-up duplex ultrasound six months after an initial acute right tibial DVT; imaging now shows chronic, organized post-thrombotic changes with no new acute clot.
| Field | Code | Rationale |
|---|---|---|
| CPT | 93971 | Unilateral limited duplex scan performed for interval follow-up of known DVT. |
| PDx | I82.541 | Chronic embolism and thrombosis of right tibial vein — NOT I82.441, since imaging confirms this is now a chronic, organized, post-thrombotic finding rather than a new acute event. |
Tip
Sequencing/CDI note: this scenario intentionally illustrates why I82.441 must never be reused indefinitely for follow-up encounters on a resolved acute event — once the clot is documented as chronic/organized, the code must transition to the I82.5x chronic series.
⚠️ Coding Pitfalls and Tips
- Pitfall 1: Defaulting to I82.441 for any documented “DVT” without confirming both laterality and the specific vein level; Tips: always cross-reference the duplex ultrasound report for the exact vein named before finalizing code selection.
- Pitfall 2: Continuing to report I82.441 (acute) at follow-up visits after the thrombus has organized into a chronic/post-thrombotic state; Tips: query the provider for acute-vs-chronic status at each follow-up encounter rather than carrying the acute code forward by default.
- Pitfall 3: Failing to separately code long-term anticoagulant use (Z79.01) when a patient remains on anticoagulation past the acute treatment phase; Tips: this is a distinct CC-capturing code and should be reviewed at every encounter where anticoagulation is continued.
- Pitfall 4: Missing a coexisting pulmonary embolism diagnosis because it “seems implied” by the DVT; Tips: I82.441 does not include PE — code I26.- separately whenever imaging or clinical documentation confirms it.
- Pitfall 5: Applying the I82.4Y-/I82.4Z- Excludes1 note incorrectly to I82.441, assuming a specific named-vein code cannot be reported due to that exclusion; Tips: remember this Excludes1 note governs only the unspecified-vein I82.40 branch, not fully specified codes like I82.441.
- Pitfall 6: Omitting a concurrent MCC/CC on an inpatient stay, unnecessarily defaulting the case to the lowest-weighted DRG 301; Tips: perform a thorough secondary-diagnosis review whenever I82.441 is the principal diagnosis on an inpatient claim to ensure the DRG accurately reflects case complexity.
📚 Sources
1. HCC Buddy. *I82.413/I80.211 — CMS-HCC V28 and V24 Risk Adjustment Mapping.* 2026. https://hccbuddy.com/icd10/I82.413 2. ICD10Data.com. *2026 ICD-10-CM Diagnosis Code I82.441 — MS-DRG v43.0 Grouping.* 2026. https://www.icd10data.com/ICD10CM/Codes/I00-I99/I80-I89/I82-/I82.441 3. ICD10Data.com. *2026 ICD-10-CM Diagnosis Code I82.441: Acute Embolism and Thrombosis of Right Tibial Vein.* 2026. 4. ICD10Coded.com. *I82.44 ICD-10 Code — Non-Billable Header, Requires Additional Characters.* 2026. https://icd10coded.com/cm/I82.44/ 5. Centers for Medicare & Medicaid Services. *Medicare Coverage Database (MCD) — NCD/LCD Search.* CMS.gov; 2026. https://www.cms.gov/medicare-coverage-database 6. Centers for Medicare & Medicaid Services. *NCD 190.11 — Home Prothrombin Time (INR) Monitoring for Anticoagulation Management.* CMS Pub. 100-03; 2026.Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.