Phlebitis and thrombophlebitis of tibial vein, bilateral

This diagnosis code signifies inflammation of the tibial veins accompanied by thrombus formation, affecting both the right and left lower extremities. It indicates a bilateral deep vein thrombosis (DVT) specifically localized to the tibial veins.

Apply this code when documentation clearly states bilateral thrombophlebitis or DVT involving the tibial veins. This is typically supported by imaging studies such as duplex ultrasound confirming the presence of thrombi in both tibial venous systems.

• Ensure documentation specifies "bilateral" involvement of the tibial veins; otherwise, a unilateral code may be more appropriate.
• Distinguish from superficial thrombophlebitis, as this code is for deep venous involvement.
• Code any associated complications, such as pulmonary embolism, separately.