One challenging coding area with the ICD-10 transition is the coding of venous and arterial lines and catheters. This article aims to provide greater clarity with regard to procedure coding tips for coding of venous catheters.
Types of Lines:
Central Lines– (CVC)- Central Venous Catheter or central lines are inserted into large veins, typically the jugular, subclavian, or femoral vein. Common uses are for medication and fluid administration.
Peripheral Lines– (PICC) a peripheral catheter inserted into a vein for prolonged intravenous access to administer medications over a long period of time. When inserted the tip of the catheter resides in the superior vena cava or cavoatrial junction. Common uses for PICC lines are chemotherapy, extended antibiotic regimens, total parenteral nutrition (TPN), and blood samples for laboratory tests.
Arterial Line– (also known as: a-line or art-line) a thin catheter inserted into an artery; most commonly radial, ulnar, brachial, or dorsalis pedis artery. Most frequent care settings are intensive care unit or anesthesia when frequent blood draws or blood pressure monitoring are needed. Arterial lines are generally not used for administration of medications or fluids.
ICD-10-PCS Coding Tips for Venous and Arterial catheters:
- Physician documentation is needed for the intended use of the line and the anatomical site that the catheter ends up.
- AHA Coding Clinic 3rd Quarter 2014 page 5-6, advices that imaging reports can be used to identify end placement of the catheter for appropriate body part coding when provider documentation does not specify.
AHA Coding Clinic Advice For ICD-10-CM/PCS Related To Venous Catheters & Lines
Below are several AHA Coding Clinic references related to catheters and other venous access devices for ICD-10-CM/PCS that may be beneficial while coding or researching this topic.
Use of Imaging Report to Confirm Catheter Placement- Q3 2014
When coding the placement of an infusion device such as a peripherally inserted central catheter (PICC line), the code assignment for the body part is based on the site in which the device ended up (end placement). For coding purposes, can imaging reports be used to determine the end placement of the device?
When the provider’s documentation does not specify the end placement of the infusion device, the imaging report may be used to identify the body part.
Device Character for Port-A-Cath Placement- Q4 2013
…venous access port. An incision was made in the anterior chest wall and a subcutaneous pocket was created. The catheter was advanced into the vein, tunneled under the skin and attached to the port, which was anchored in the subcutaneous pocket. The incision was closed in layers. When assigning an ICD-10-PCS code for insertion of a port-a-cath, what device character should we select? Would a port-a-cath be considered a reservoir (character “W”) or a vascular access device (character “X”)?
Code only the vascular access device (VAD). The device has a small reservoir, but it does not function as a reservoir to store medicine during the course of therapy.
Assign the ICD-10-PCS code as follows: 0JH63XZ Insertion of vascular access device into chest subcutaneous tissue and fascia, percutaneous approach. In ICD-10-PCS, a percutaneous approach is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach the site of the procedure.
Totally Implantable Central Venous Access Device (Port-a-Cath)- Q2 2015
In Coding Clinic, Fourth Quarter 2013, pages 116- 117, information was published about the device character for the insertion of a totally implantable central venous access
device (port-a-cath). Although we agree with the device value, the approach value is inaccurate. The approach value for placement of a port-a-cath should be “Open” (rather than percutaneous). Furthermore, a port-a-cath is a two-part device, and requires two ICD-10-PCS codes, for the insertions of the catheter as well as the infusion device. We are asking that the Coding Clinic Editorial Advisory Board (EAB) revisit this advice.
Yes, you are correct. In the published example, a subcutaneous pocket was created
under direct visualization in order to place the vascular access port, and therefore the approach is “open” for that portion of the procedure. In addition, a totally implantable central venous access device is a two part device; therefore two ICD-10-PCS codes are required to capture insertion of the device. Assign the following ICD-10-PCS codes for placement of this type of venous access device: 0JH60XZ Insertion of vascular access device into chest subcutaneous tissue and fascia, open approach. 02HV33Z Insertion of infusion device into superior vena cava, percutaneous approach; and this advice is specific to insertion of a totally implantable venous access device, and not for a cut down to insert a central line. Most central lines are inserted percutaneously without creating a subcutaneous pocket under direct visualization, and so they are not coded with an open approach.
Insertion of Peritoneal Totally Implantable Venous Access Device-Q2 2016
A patient diagnosed with Stage IIIC ovarian cancer underwent placement of an intraperitoneal port-a-catheter during total abdominal hysterectomy. An incision on the costal margin in the midclavicular line on the right side was made, and a pocket was formed. A port was then inserted within the pocket and secured with stitches. The catheter was tunneled through the subcutaneous tissue and entered the abdomen adjacent to the umbilicus. The catheter was laid within the abdominal cavity. What is the correct code assignment for the intraperitoneal Port- A-Catheter/totally implantable central venous access device?
A peritoneal port-a-cath is a small reservoir that is surgically implanted into the subcutaneous tissue of the abdomen. The device can be used to deliver antineoplastic medications, or withdraw excessive fluid from the peritoneal cavity through a catheter connected to the port. In this case the port is being inserted into the abdominal subcutaneous tissue and fascia, not the chest wall. Two codes are assigned, one for the catheter and the other for the peritoneal port. Since ICD-10-PCS does not provide a specific code for the insertion of the peritoneal port, the closest available equivalent is “Insertion of reservoir into abdomen subcutaneous tissue and fascia.” Assign the following ICD-10-PCS codes:
- 0WHG33Z Insertion of infusion device into peritoneal cavity, percutaneous approach, for the catheter insertion
- 0JH80WZ Insertion of reservoir into abdomen subcutaneous tissue and fascia, open approach, for insertion of the peritoneal port
Removal and Replacement of Tunneled Internal Jugular Catheter- Q2 2016
The patient has a malfunctioning right internal jugular tunneled catheter. At surgery, the old catheter was removed and a new one placed. Under ultrasound guidance, the jugular was cannulated; the cuff of the old catheter was dissected out; and the entire catheter removed. An incision was then made at the entry site; a new catheter was tunneled through the subcutaneous tissue from the chest wall up into the neck. The guidewire and dilator were removed leaving the peel-away introducer in place. The catheter was threaded through the peel-away and the catheter was placed. Fluoroscopy confirmed that the catheter tip was in the right atrium. The port was aspirated, flushed and capped with heparin. The incision at the base of the neck was sutured. What are the appropriate ICD-10-PCS codes for the removal and insertion of an internal jugular tunneled catheter?
The internal jugular tunneled catheter consists of two-parts, an infusion port and catheter. Code the insertion, as well as the removal of both the infusion device and the vascular access device. Assign the following ICD-10-PCS codes:
- 02PY33Z Removal of infusion device from great vessel, percutaneous approach, for removal of the infusion portion of the catheter
- 0JPT0XZ Removal of vascular access device from trunk subcutaneous tissue and fascia, open approach, for removal of the port
- 02H633Z Insertion of infusion device into right atrium, percutaneous approach, for insertion of catheter