Chronic venous insufficiency of the lower limb and Varicose veins of the lower limb G045

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-9-CM Codes: 459.1.459.81, 454, 671, 671.0, 671.03 and 671.04
• ICD-10-AM Codes: I87, I87.2, 183, O22.0

Brief description

The term chronic venous insufficiency covers impairment of venous blood flow from the legs.  This can manifest as dilated (but not varicose) superfical veins on the foot and ankle and various skin changes (pigmentation; exczema like changes; lipodermatosclerosis, which is inflammation and scarring of the fat layer under the skin with hardening and swelling of the skin; and venous ulcers.

Varicose veins are veins that have become enlarged, elongated, tortuous and easily visible.  They develop when the valves in the veins that prevent blood flowing backwards cease to function correctly.  Varicose veins are most common in the legs but can occur elsewhere.  The SOP is confined to varicose veins of the lower limbs.

Confirming the diagnosis

The diagnosis is made clinically.  No specific investigations are required for diagnosis. Ultrasonography is commonly used to deliniate the extent of the disease.  The relevant medical specialist is a general surgeon, although specialist opinion will not generally be needed.

Additional diagnoses covered by SOP

• lipodermatosclerosis
• sclerosing panniculitis of the lower limbs (synonym for lipodermatosclerosis)
• stasis dermatitis of the lower limbs
• Venous eczema of the lower limb
• Venous ulcer of the lower limb

Conditions not covered by SOP

• deep vein thrombosis*
• oesophageal varices^#
• superficial thrombophlebitis^#
• varicocoele*

* another SOP applies

^# non-SOP condition

Clinical onset

Clinical onset will be based on the history of when the varicose veins first became apparent, when skin changes, limb discomfort, pain or swelling (worse with standing) due to the varicose veins or the chronic venous insufficiency first began. Medical attention/treatment may not be sought for an extended time (years) after the conditions first manifest.

Clinical worsening

Both varicose veins and chronic venous insufficiency will typically slowly worsen if left untreated.  Varicose veins can be effectively treated by ablation therapy or surgery.  Clinical worsening of varicose veins may be evidenced by a step up in the extent of the disease or by progression to more advanced manifestations such as stasis dermatitis and ulceration.