14. Totally Implantable Port with VAD
There are two codes needed for Totally Implantable Port with VAD since these are two-part devices. The first code is for the totally implanted port. The second is for the central vein catheter insertion.
A needle is used to access through the skin to reach the port. This process is also sometimes called “Medi-port;” “Port-a-Cath;” or “Groshong port.”
Coders should code for an open approach for implanted port and code to location within subcutaneous and fascia body area.
For central venous catheter, code percutaneous and to body area of where the tip ends up (i.e. right atrium, SVC)
Coding Clinic 4Q 2015 pages 26-32 also addressed this but it is very confusing. Follow Coding Clinic 2Q 2015 page 33 as it is accurate and easier to follow.
Totally Implantable Reservoir and Pump with Catheter
In this case, three codes are needed: Reservoir implantation PLUS pump implantation PLUS central catheter insertion. A needle is used to get through skin to reach reservoir to fill it.
For totally implantable VAD, reservoir and pump, Code 0JH60VZ is surgical DRG. Note that it is rare that you will see this type of VAD with pump and reservoir.
15. Control of Bleeding
There is confusion on when to assign root operation “Control.”
Control: OCG B3.7
The root operation Control is defined as, “Stopping, or attempting to stop, post procedural or other acute bleeding.” If an attempt to stop post procedural or acute bleeding is initially unsuccessful, and to stop the bleeding requires performing any of the definitive root operations Bypass, Detachment, Excision, Extraction, Reposition, Replacement, or Resection, then that root operation is coded instead of Control.
Example: Resection of spleen to stop post procedural bleeding is coded to Resection instead of Control.
AHA Coding Clinic 3Q 2013 page 23 states that control of bleeding at the time of the procedure is inherent in the overall procedure and not reported separately, even if it requires additional time and effort.
AHA Coding Clinic 4Q 2014 page 20 for Control of bleeding of duodenal ulcer, 0DQ98ZZ is NO LONGER APPLICABLE. The repair of duodenum may now be obsolete given new definitions of Control.
- DRG affected, K92.2, GI bleeding as PDX
- “Repair” 0DQ98ZZ = DRG 328, Digest. Proc w/o CC/MCC
- “Control” 0W3P8ZZ = DRG 379, GI hemor w/o CC/MCC
Thank you for reading!
I hope you have enjoyed reading Common ICD-10 Errors Found in Audits. Please keep in mind that the information contained in this series is valid at the time of posting. Readers are encouraged to take the following actions to stay up-to-date on any official guidance:
- Continue to study the ICD-10-PCS Guidelines.
- Become very familiar with the root operations and their description for use in ICD-10-PCS.
- Carefully review Coding Clinic and if a situation is not addressed, send in to Coding Clinic for official advice.
- Look at coding forums such as “Engage” to see if someone else encountered the same problem and found a solution.
- Check with vendors to see if they have resolved any issues
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The information contained in this coding advice is valid at the time of posting. Readers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
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